M3: Interactive Activity

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Laura M. Justice and Erin E. Redle

© 2014, 2010, 2006 Pearson Education, Inc. All rights reserved.

Chapter 6 Communication Assessment and

Intervention: Evidence-Based Practices

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-2

Focus Questions 1. What is evidence-based practice? 2. What is assessment? 3. What is intervention? 4. What are some common approaches

to intervention for communication disorders?

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-3

Introduction  People in the field of communication sciences

and disorders fill a variety of roles.  Key responsibilities include assessment and

intervention, or diagnosis and treatment.

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-4

What Is Evidence-based Practice?  Integrate knowledge from several

perspectives scientific evidence  Clinical expertise  Client perspective  Definition

 Process by which the clinician integrates these three areas to arrive at the best plan of action for a particular client

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-5

What Is Assessment?  Assessment

 the systematic process of gathering information about an individual’s background, history, skills, knowledge, perceptions, and feelings.

 Involves may disciplines with diverse knowledge, skills, and experiences.

 A test is merely part of a complete assessment.

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-6

Purposes and Processes of Assessment  To identify skills that a person has, and those the

person does not have in a particular area of communication.

 To guide the design of intervention for enhancing a person’s skills in a particular area of communication.

 To monitor a person’s communicative growth and performance over time.

 To qualify a person for special services.

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-7

Screening and Referral  This tasks are completed to identify

those who may require a more comprehensive assessment.

 Screening: test or task to conduct a quick check of performance.

 Referral: when a professional’s help is formally requested.

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-8

Designing and Administering the Assessment Protocol  Chart review  Interviews  Systematic observation  Questionnaire/survey  Formal test  Instrumentation

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-9

Formal Testing: Norm-Referenced and Criterion-Referenced Tests  Norm-Referenced Test

 Used to compare performance with that of a same-age peer

 Criterion-Referenced Test  Used to determine level of achievement in

a particular area

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-10

Norm-Referenced Tests Standardization Test must be given in a uniform and scripted manner so that it is given in exactly the same way to everyone who takes it Normative sample A group of individuals who were given the test to identify standards of performance at specific age levels

Standard scores The index that identifies how a person’s test performance compares to that of their normative peers. Diagnostic accuracy The ability of a test to correctly describe a condition

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-11

Standard Normal Distribution  Standard Normal Distribution

 Derived from mathematical models of probability regarding how scores will range from a skill or aptitude that is assumed to be normally distributed within the population

 Terminology  Raw Score  Normal Curve  Mean  Standard deviation  Percentile Rank

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-12

Criterion-Referenced Tests  Criterion-referenced assessment

 to determine an individual’s level of achievement or skill in a particular area of communication

 Instruments  Require establishment of a clear standard of

performance  Require design of specific tasks  Must provide clear guidelines for interpretation

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-13

Dynamic Assessment  Analyzes how much and what types of

support or assistance are needed to bring an individual’s communicative performance to a higher level

 Leo Vygotsky’s influence

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-14

Interpreting Assessment Findings  Steps to interpret assessment findings

 Diagnosis  Differential Diagnosis

 Determine the severity of the disorder  Very mild, mild, moderate, severe, and very

severe  Characterizing the client’s prognosis

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-15

Developing an Intervention Plan

 Components of an intervention plan:  Identifying treatment goals  Describing the possible length and

frequency of treatment  Describing treatment contexts and

activities

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-16

Monitoring Progress and Outcomes  Not a one-shot deal that stops when the diagnosis is

made  An ongoing process that monitors progress and

outcomes for the client  Purposes

 Monitor a client's progress during treatment  Modify the treatment plan as progress is made  Determine when a client should be discharged from

treatment

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-17

What Is Intervention?  Definition

 Refers to the implementation of a plan of action to improve one or more aspects of an individual’s communicative abilities.

 Qualities  Effectiveness  Efficient  Feasible

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-18

Purposes of Intervention  Prevention  Remediation  Compensatory

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-19

Intervention Planning  Goal

 Targeted communication achievement of an individual

 Procedure  The clinician’s plan of

action  Goal characteristics

 Functional  Measurable  Attainable

 Phases  Phase 1: the professional

sets long-term for a client, the anticipated outcomes of therapy

 Phase 2: the professional sets the short-term goals that will lead to the desired long-term goals

 Phase 3: the professional sets session-level goals for a client that are written in measurable and observable terms

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-20

Intervention Models  Pull-out/direct service  Co-teaching/parallel instruction  Intervention consultation

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-21

WHAT ARE SOME COMMON APPROACHES TO INTERVENTION FOR COMMUNICATION DISORDERS?

 Behaviorist Approaches  Linguistic-Cognitive Approaches  Social-Interactionist Approaches  Family-Centered Interventions

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-22

Behaviorist Approaches  Based on classic learning theory, which emphasizes

the importance of the environment for shaping behavior and, in particular, the influence of consequences on behavioral change.

 Terminal Behaviors  Clinicians are responsible for

 Identifying observable and measurable goals  Specifying the level of mastery at each goal  Controlling each intervention session  Collecting data in each session

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-23

Linguistic-Cognitive Approaches  Based on theories of developmental psychology and

cognitive science, which emphasize the developmental sequences and underlying rule- governed organization of communicative behavior

 Parameters  Goals of communication acquisition: when, how, and why  Helping the individual lean the rules that underlie successful

communication  The learner is engaged fully in the intervention process

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-24

Social-Interactionist Approaches  Based on theories of developmental psychology that

emphasize the importance of social interactions among individuals as a critical means for development and learning

 Vygotsky’s influence  Terms

 Social plane  Psychological plane  Zone of proximal development  Scaffolding

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

© 2014, 2010, 2006 Pearson Education, Inc. All Rights Reserved.

6-25

Family-Centered Intervention  Built upon the concept of family systems

theory, which emphasizes that “the family as a whole is greater than the sum of its parts”.

 Treatment goals emphasize an individual’s participation within and access to family activities and contexts, and may incorporate family members’ perspectives regarding viable treatment approaches.