Brain Injury & Concussion Clinic (BrICC)

Brain Injury & Concussion Clinic (BrICC)

School-Age SpeechLanguage-Social Skills Center Fall 2019 SUPERVISORS: FRANK BENDER, ALYCIA CANAVAN, S ARA STARLIN (MAPLE ELEMENTARY SCHOOL), KATIE MASON, LORI HORNFELT Introductions 1st Years: Name Where you are from?

What fears do you have about Graduate School or this clinic? 2nd Year: Name Where you are from? What would you like to learn from this clinical experience?

One piece of professional advice would you provide to the 1st year graduate students? Todays Schedule Briefly Review the Clinic Calendar and Group Meeting Schedule & Topics Peer mentor responsibilities Overview of the School-Age Speech, Language, and Social Skills Center and quick review of the content areas that are typically addressed in this clinic An overview of both formal and informal assessments Preparing for your 1st Session Second Years Dismissed Logistics with 1st Years

Work on preparing CHARTR & Lesson Plans Review the Clinic Calendar and Group Meeting Schedule* Review the Flow of the Term Use this document as a schedule and checklist Watch for Important Due Dates This is posted on infoCDS under the School-Age Specialty Center

Group meeting slides will be posted under the group meeting tab on infoCDS Peer Support Groups and Responsibilities Kenny ODea Isabella Carino Brandon Zuel Provide clinic logistical support when needed.

Katie Coles Lauren Hudgins Be available to answer client specific questions associated with evaluation, goal development, or treatment. Sofia Dorantes Zella Kourafas Melissa Garibay Caitlin Kuel

Alyssa Campos Jessica Johns Be available to answer questions regarding the clinical experience Be available to answer questions regarding clinical documentation (i.e., CHARTR, Lesson Plans, SOAPs, Evaluation Reports, and ITPs You will not be required to grade or read through all clinic documentation requirements or participate in the

clinical session with your assigned partner. Purpose of the School age Speech and Language Specialty Clinic Purpose of services is to facilitate each childs ability to functionally communicate in all environments and successfully participate in grade level/ageappropriate school and home activities. Who We Will Serve: Population: The clinic will serve children who are

kindergarten through 12th grade with communication disorders specific to speech, language, cognition and hearing loss. Deficits include: Speech sounds/articulation, language (phonology, morphology, syntax, semantics, pragmatics/social skills) and hearing loss. Service delivery models: In UO Speech Language Hearing Center (UOSLHC) and at Maple Elementary Individual & group sessions (or a mix) to

best support individual needs. What is a Communication Disorder? An impairment in the ability to receive, send, process and comprehend concepts or verbal, nonverbal and graphic symbol systems. It may affect individuals abilities to speak, read, write, process information or interact socially. What do SLPs do who provide

service for school-age children? 1. Speech production 2. Language 3. Cognition not specific to head injury/TBI 4. Feeding and Swallowing 5. Fluency 6. Voice 7. Resonance 8. Auditory habilitation/rehabilitation What is a Speech Disorder?

An impairment of articulation, speech sounds, fluency, or voice What is a Speech Sound/Articulation Disorder? An atypical production of speech sounds characterized by Substitutions (tool/cool, wash/watch) Omissions (sip/slip, boo/book) Additions/Distortions (lisps, wabbit/rabbit) This disorder may affect intelligibility. Significant speech sound disorders impact a childs selfesteem, peer relationships and ability to read, spell and

write accurately. What is a Language Disorder? A language disorder is impaired comprehension, and or use of spoken, written and/or other symbol systems. The disorder may involve in any combination the form of language (phonology, morphology, syntax); the content of language (semantics); and/or the function of language in communication (pragmatics/social).

What are the different types of language disorders? Phonology Morphology Syntax Semantics Pragmatics/Social Language Phonology Study and use of individual sound units in a language and the rules

by which they are combined and recombined to create larger language units. Phonemes are the unit of sound such as /s/ or /b/ , they do not convey meaning. Phonemes alter meaning of words when combined (e.g., sat to bat). Phonological Deficits Frequently appear as articulation disorders. Child omits a consonant: oo for too Child substitutes one consonant: wabbit for rabbit Discrimination: child hears go get the nail instead of mail

Morphology Study and use of morphemes, the smallest units of language that have meaning. A morpheme is a group of sounds that refers to a particular object, idea, or action. Roots can stand alone (e.g., car, teach, tall) Affixes are bound such as prefixes and suffixes and when attached to root words change the meaning of the words (e.g., cars, teacher, tallest)

Morphological Deficits Elementary aged: may not use appropriate inflectional endings in their speech (e.g.,He walk or Mommy coat). Middle school: lack irregular past tense or irregular plurals (e.g., drived for drove or mans for men). Be aware of cultural dialects: John cousin, I have two book Syntax Study of the rules by which words are organized into phrases or sentences in a particular language. Referred to as the grammar of the language and allows for more

complex expression of thoughts and ideas by making references to past and future events (This is extensively covered in Dr. Nippolds class). Syntactic Deficits Lack the length or syntactic complexity (e.g., Where Daddy go?). Problems comprehending sentences that express relationship between direct or indirect objects. Difficulty with wh questions.

Semantics The larger meaning component of language. More than single words, includes complex use of vocabulary, including structures such as word categories, word relationships, synonyms, antonyms, figurative language, ambiguities, and absurdities. Classes of words (e.g., pronouns, nouns, verbs, adjectives, adverbs, prepositions, articles, conjunctions, etc.) Struggle with understanding or using temporal or spatial prepositions (impact on following directions or impacting reading comprehension)

Semantic Deficits Limited vocabulary especially in adjectives, adverbs, prepositions, or pronouns. Longer response time in selecting vocabulary words. Fail to perceive subtle changes in word meaning: incomplete understanding and misinterpretations. Struggle with interpreting comments or written language that uses inferencing and figurative language. Pragmatics Knowledge and ability to use language functionally in social or

interactive situations. Integrates all the other language skills, but also requires knowledge and use of rule governing the use of language in social context. Pragmatic Deficits Problems understanding indirect requests (e.g., may say yes when asked Must you play the piano?). May enter conversations in a socially unacceptable fashion or fail to take turns talking. Difficulty staying on topic.

What are Cognitive Disorders? Cognitive disorders refers to difficulties with: Attention Memory Problem solving Executive functioning These may be due to a syndrome, birth defect or traumatic brain injury (TBI), The TBI may be the result of concussions or other head injuries. What is Auditory

Habilitation/Rehabilitation? Working on speech, language, listening and communication skills that are affected by hearing loss, deafness. Assessment and Data Collection Informal vs. Formal Speech, Language, & Social Skills Baseline Assessment Criterion-Based Assessment v. Norm-Referenced Standardized Assessments.

Data Collection for Both Approaches See slides on infoCDS and information on data collection methods. Formal Norm-Referenced Standardized Assessment Typically administered for a new client or a client who has not been formally evaluated over the last 1.5-2 years OR. If there is another concern that you are exploring. Parent / Client Interview Include all HEDCO documents if they have not been completed (Permission to Evaluate & Serve and Release of Information). See example documents on infoCDS

Standardized Norm-Referenced Testing Speech Sounds, Language, and Social Communication Discuss New Tests Ordered Additional Dynamic Assessment to identify stimulability or levels of cuing support Language / Conversational Sampling Oral Mechanism Evaluation Hearing Screening Complete an Evaluation Report (Template and Example on infoCDS) Determine if the client meets criteria for a diagnosis (ICD-10 Code), requires services, and the focus of service.

Where to Start and What to Focus On Using a CriterionBased Assessment For returning clients, its recommended to use the previous ITPs and the noted recommendations as a guide to where to begin developing your clinical question, which will direct your focus for developing a criterionbased assessment. Discuss some examples including clients who met their objective criteria last term. Once you identify a target to probe, your first attempt to elicit a clients ability to complete a task should be done without cues or prompting. This provides you data regarding a clients Zone of Actual Development. If the client does not perform well without cuing, it is then appropriate to continue exploring this target using more of a Dynamic Assessment approach to identify the levels of cuing the client requires (or the level

of stimulability) to identify their Zone of Proximal Development. Use enough opportunities to allow you to identify a pattern of productions that can be ruled out as random guessing. Obtaining a count of 5-10 productions should provide you with enough data (depending on the target). What are you tracking? Correct v. Incorrect productions, levels of cuing, automaticity, distractibility, etc. Criterion-Based Assessment A formative assessment approach typically used during intermittent time frames to gauge changes in treatment progress (e.g., returning clients following a break, post assessment at the end of a term).

Identifying what the client can and cannot do compared to a predefined criterion (Not comparing to a sample of the population). These tests help answer the question, How does my clients performance compare to an expected level of performance? They can be used to establish a baseline May continue as needed throughout the term to determine progress/assess effectiveness/look for new goal(s) Completed at the end of the term to show progress All Returning Clients:

Components of an Informal Assessment Parent Interview: Identify any updated information, any changes, observing any transfer and generalization, current concerns and priorities. Updated HEDCO documents Updated information on Family, Home, Medical, and School Identify previous targets that have not not been met (or just recently met criteria) Use a an informal criterion-based developed assessment to establish current baseline and/or progress or regression

Conduct a qualitative language / conversational sample If you need hearing screening hours, all of your clients will get a hearing screening Track your data Identify the priority for the term (based upon your data and parents request) Target 2 3 long-term goals for the term * Dont reinvent the wheel. Use the recommendations by the previous clinician and the previous ITPs to help you prioritize. Parent Interviews

Mock parent interview: Why the parent interview is so important: Informal Tests of Phonology Analyze students production of phonemes in single words and/or phrases or sentences Choose target sounds based upon previous reports, observations, or parent report. Probe target sounds in different positions (e.g., initial, medial, final,

blends). When considering the target word, think about the complexity (e.g., cognates, target sound in multiple positions, syllabication) Provide prompts Tell me about your weekend for 3-minute sample, count correct and incorrect phonemes. Following the informal assessment, you can then conduct a stimulability test (i.e., a form of Dynamic Assessment) Informal Test of Morphology Determine mastery level of each morpheme in a hierarchy (Brown, 1973).

ing: present a picture of girls playing and say The girls like to play. Here they are ________. Student adds missing word. Show a series of 20 action pictures and ask student what they are doing. Accuracy below 90% - morpheme has not been mastered Informal Tests of Syntax Expressive Syntax: Engage in a conversation or have the student provide a narrative about a topic: Analyzing students spontaneous speech and note the

syntactical errors. Sentence Repetition: Clinician states a sentence with a certain syntactical structure and the student repeats it. Note any errors. Informal Tests of Semantics Logical relationships: Cause-and-effect, and verbal problem solving: Structured picture cards or literature-based Verbal opposites: Picture cards of 40 pairs of opposites. Student sorts them into opposites. Word categories: Clinician says a word and student says as many words in

the same category. Clinician provides picture cards and student puts them into proper categories Semantic relationships: Asking client questions or using picture cards to elicit complex language relationships: Synonyms, antonyms, figurative language, ambiguities, absurdities. Informal Test of Pragmatics Analyze spontaneous speech and behavior (use of reviewing a videotape tape can be helpful) Classify pragmatic functions Measure for appropriate loudness, talking at inappropriate times,

interrupting the speaker, and using indirect requests, topic maintenance, conversational skills, perseverative behaviors, time-ontask, etc. Assessment and Intervention Approaches Resources on infoCDS: Resources to Assist with Your 1st Session Review

information on infoCDS regarding assessment and intervention. Review sections in your textbooks for language disorders and speech sound disorders. I also have many additional books. Review posted materials on infoCDS regarding data collection strategies. Review posted materials on infoCDS regarding behavior management techniques. Preparing for 1 Session st

If you havent contacted your client to confirm clinic sessions, please do that ASAP If you have a returning client, I would encourage you to reach out to the previous clinician (if they are on campus) and to review previous video. If you have questions about this, please let me know. Have your lesson plan reviewed by your supervisor and bring with you during your session Collect and practice with any informal assessment material Create any needed visual schedules for your lesson Bring a back-up activity Jut in case Know how to record your session & maybe have a separate your recorder Have your data collection system developed Have all documents for parent to sign - this can be done while you are working with the client. Use the File Review Checklist to help you

organize the documents. Client Cancellations or Need to Reschedule Days and Times: What to do ! Supervision and Feedback Supervisors are required to supervise 50% of your evaluation time and 25% of your treatment time. You will likely receive written feedback following each clinical session with the amount of time that was observed by your supervisor. These are typically emailed to you following a session (or within 24 hours). I use the supervisor feedback form posted on infoCDS. However, your supervisor may have a different format.

I would recommend checking with them to identify how clinical feedback will be provided. Session Feedback from Supervisor Written Verbal * This may look different for different supervisors, so please talk

with them regarding their approach. When reviewing your client files, see if there are any updated forms that may need to be collected during your first parent meeting. This information can be identified within the File Review

Checklist and the documents that follow. RDS File Conventions Whats Up Next You will complete your CHARTR and lesson plans and have it posted on RDS by 7pm on Friday. Myself, or the other supervisors, will be available to answer Qs. Again, contact our families and confirm dates and times. Check Titanium Schedule for your room assignments for your client

Review and practice the video recording technology for your session. Continue to review the clinic calendar as your operating checklist Review previous video sessions of your client for ideas and support Use infoCDS to leverage resources, documents, and examples I will have a schedule posted outside of my door to schedule individual Hearing Screenings Training and Schedule. The schedule may fluid during start up based upon the OSHA conference and school schedules. Be prepared to discuss your client and your initial plan during the next group meeting. An outline will be posted 2nd Years Excused ~ 1st Years

Stay Documentation Logistics CHARTR Questions Lesson Plans SOAP Notes ITPs Clinical Feedback Lesson Plan Draft This will be your plan that goes into your clinical session To be posted in RDS at least 24 hours before your session

See RDS for blank copies and examples listed in previous client RDS files. CHARTR Questions You only need to complete sections 1-3 for this Friday. Sections 4-5 will be completed by the end of week 3. SOAP Notes * To be completed and posted at least 24 hours following your session What is a SOAP Note? A form of documentation, typically used in the medical field, as a form of communication and summary of any form of evaluation or treatment performed with a client.

SOAP Stands For: Subjective: Subjective and non-measurable information that may come from the client or caregivers point of view. However, it could also explain certain behaviors observed during a session which will be addressed in the A section. Objective: This section contains measurable finding Your raw data. For your first assessment session, you may note that you performed a certain assessment, and whether it was completed, and refer to the ITP for specific results. Assessment (analysis): This is a synthesis of your information from your S and O section. You do not reiterate the raw data. Here you would note what might have influenced the data and student performance (e.g., fatigued, level of cuing, etc.) Plan: Note your recommended plan of action for your next session (bullet points are fine). This will direct you in

crafting your next lesson plan * See Slides Posted on infoCDS under Group Meetings ITPs Individual Treatment Plans Use the most recent ITP for your client located in RDS as a possible template and then make updated changes See the example posted on infoCDS that will reflect the information

that you should include in your ITP. Your draft is due week 3 primarily so you have your LTGs and STOs mapped out. The final draft will go to the parents at the end of the term. THANK YOU! QUESTIONS / COMMENTS / CONCERNS?

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