*GLBT Community

*religions

*family members incarcerated

*Race, gender, ethnicity, religion, age, nation orgin etc.

*Clinicians do not exclude clients from their professional practice for reasons other than the person's potential to benefit from our services. 

*Communication disorder beyond clinician's level of expertise.

*Exercise judgement about the content, frequency, and duration of services that are recommended when referral comes to you (aka do your own independent eval.)

*NOt accepting gifts or bribes to influence our decision making.

*Told about Communication disorder and are informed about the relative strengths, weaknesses, risks associated with a recommended plan of action or incation. 

*Client gets to exercise autonomy, can choose to withdraw at any point. 

*Only share privileged information only with people directly responsible for client management and/or care and only for purposes related to the client's welfare. 

*Careful in hospital elevators and teacher faculty rooms.

*Precendents may override client's right to confidentiality....clients telling you they want to kill themselves, have suffered abuse etc. 

Make reasonable statements that describe the likelihood that a behefit will be gained from treatment.

*We do not recommend treatment for evey person who has a speech-language or hearing disorder.

Hygienic precautions: hand washing, disinfecting equipment.

*Universal precuations everywhere: Home care, schools etc. Wash your hands etc. Do not handle bodily fluids/infections of young children without gloves etc.

* Hand washing

*Disposable gloves

*Contaminated Items

*Decontamintaion/disinfection 1/10 bleach 9/10 water.

*Illness: Do not come to work when ill. Wear a mask when you have a cold.

*Vaccinations: Clinicians -hepatitis B, rubella, mumps, hearly tuberculosis test. 

*appropriate diagnosis

*thematic procedure

equipment working order

*Records maintained up to date (IEP) etc.

*specializations.

*Benefience/Nonmaleficence

*Nondiscrimination

*Referral

*Informed Consent

*Confidentiality

*Prognosis/Cure

*Infection Control

Achieved by reading textbooks, journal articles, attending workshops, taking acourse, participating in research, conferences. 

*Clinician's monitor eachother for ethical principles. 

Contemporary

Issues

Competition: Must balance ethics with competition for employment and the market share. 

resources

health care

scope of practice

paraprofessionals

SLP/audiologist accepts personal or financial gifts from clients or manufacturers that comprise professional judgement because of strings/expectations attached.

*Causes a loss of objectivity.

Self-dealing

(Falls under conflict on interest)

Primary Audience?

What purpose are they reading?

Current level on the subject?

What context are they reading?

*Audience requires more advance, specialized, vocab.

*Current References required

*format?

*Has no special or expert knowledge.

*Human interest aspect of the article.

*Definitions and description. 

*Attratice graphics/visuals.

May or may not have more knowledge than the lay audience about a a subject. 

*Needs knowledge so they can make a decision about the issue. Still define and give examples.

*Most demanding in terms of knowledge, presentation, graphics, or visuals.

*elaborate/technical

Means to see again. Look @ something from a fresh critical perspective. Revision is NOT proof reading. 

*Is everything in your document worth saying?

*Topic too big, or too narrow?

*Address purpose of writing?

*Balance of subjects. 

*order of things.

*misleading statements?

*Looking at overall motor coordination when walking into your office.

*Asymmetry of features.

*Breathing: Open mouth breather/saliva management

*Adequate breath support

*Voice quality

*Facial symmetry

*tremors, ticks, weakness on one side

*spacing of eyes ears, mouth

*unusual scars, evidence of cleft?

*Discriminate tactile sensation: soft touch, hot vs. cold, while closing their eyes.

Fetal Alcohol Syndrome

(FAS)

Between nose and lip. LONG gap. 

small eye slits.

Is it symmetrical resting/speaking?

*Observe natural smile

*Series of lip movements and observe for mobility. 

*Model what you want them to do first.

*Adequate lip seal: fill cheeks with air and hold for 10-15 seconds.

*Movement and stability of the TMJ is important for speech as well as chewing

*Alignment

*Adequate movement versus clenched jaw

*Noises:grinding/popping

*over/under bite?

*deviatied septum or obstruction of nasal cavity,

*nasal air emission during speech. mirror under nose while making non-nasal sounds. No emission of air on mirror.

*Boogers?

*Hypernasal: cleft, result of swollen tonsils or adenoids.

*look for symmetry across both ears

*Size and location of pinna

*growth on pinna?

Palate: ridges?

*Hard and soft aplate.

*Provides division between oral and nasal cavity. 

*Pink health color

*Needs to be able to close of nasal cavity quickly for running speech and swallowing?

*Gag reflex

*Uvula. One uniform shape.

Observe for:

*Weakeness of either side of soft palate

*Length of soft palate

*Nasal Emission (velopharyngeal insufficiency)

*possible cleft? roof of mouth is not fused together.

*Fistula

*Observe soft palate elevation

*quality of phonation while saying ah.

*Note conditions of the teeth and gums, missing teeth?

*Note any presence of dental work: cavities, caps, braces, brdiges, retainers, etc.

*Orthodontic work referrals- be careful most insurance does not cover. warn client!

*history pertinent to disorder/appropriate to client

*Child's prenatal and birth history (maternal health), neonatal health.

*Birthweight/birthdate (gestation)

*Pertinent illness or injury.

*hospitalization

*respiratory infections

*allergies

*ear infections/how treated

*other speech-language audiological evals. results? When and who did the screening/testing

*Table format

*Explain what the standard scores mean.

*Include other observations(lang. sample) as well.

*Oral Motor Exam

*Hearing Screening

*Language: Expressive (syntax, semantics), Receptive Language, Pragmatics

*Articulation/Phonology

*Fluency/prosody/voice quality

*Formulate diagnostic statement

*Summary of relevant findings

*Highlight problem areas.

*No New information

*Use behaviors and test scores previously reported as evidence

*State whether therapy is recommened and frequency/type

*Prognosis

*other recommendations: counseling? etc.

*Concern the family in acceptance of recommendations.

*Can recommend further testing to know more

*diagnostic statement

*severity

*significant aspects of problem

*possible sources of problem.

*order of severity.

*hypothesis, impressions, predictions

*Increase participation

*increase intrinsic motivation

*curiosity

*promotes learning

*child learn's from mistakes.

A) Does not use objects.

B) Real Objects.

C) Substitutes Objects for other objects

d)imaginary objects

*Sound system/overall speech Intelligibility.

*Fluency

*voice quality/resonance.

*Kinds of functional comprehension skills.

*types of intenions (desire), frequency, means.

*type of comprehension strategies exihibited.

*effect on the listenenr

*nonverbal eyegaze/body orientation

*covey message turned into words
*persistant til objective obtained

*Show emotion (angry/happy)

*Basic words/sentence structure are being acquired.

*Limit number of yes/no questions (closed ended).

*Say many false statements - complex language

*75-100 utterances

*Verbatim when transcripting.

*consistant error patterns

*variety in structures or repetition?

*Specific vs/ non specific

*missing, emerging, mastered

*frequency of initating

*reciprocating/engaging

*following clinician's lead

*eye gaze

*social routines

*topic maintenance

*easily distracted (new excitement)

*retelling a story

*family photo album

*describe pictures,

*sequence of cards

*relaying appropriate amount of info.

*new info. has errors?

*incompleteness

*verbosity

*Do statement

*Condition

*Criterion