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Clinical Assignment 5: Settings and Certifications Elizabeth Rubin SUNY New Paltz

Rubin 2 Within the field of Speech Language Pathology, a therapist has various options as to what setting and population to work with. These settings could include public and private schools, acute care facilities, long term care facilities, outpatient clinics, private practices, early intervention, and specialty clinics. (Burke, 2016). Depending on the degree or severity of a diagnosis, certain settings are more appropriate than others. For instance, in an acute care facility, patients are there for a short-term treatment. Clinicians in this setting primarily treat patients who suffer from a CVA or a traumatic brain injury. Clinicians evaluate and then assess these patients either bedside or in a separate therapy room. Particularly in this setting, the patients are short-term, but the caseload varies on a daily basis (Burke, 2016). In contrast, a nursing home which houses long-term patients, treat those who suffer from Alzheimer’s disease, Huntington’s disease, and additionally neurological diseases. Even though the majority of the patients are long-term, the variety of patients is still high (Burke, 2016). Additionally, there are out-patient clinics that treat those who receive services and are able to arrive to the facility on their own. In these facilities, age, severity of disorder, and type of disorder range across the board. Within these facilities, specialty clinics are provided for those who have stutters, voice disorders, or dysphagia. These specialty clinics are run similarly to how an out-patient care facility runs. These settings are widely popular within the Speech Language Pathology fields. In addition, there are also educational areas that Speech Pathologists can work in. These include early intervention, preschools, and other school populations. In early intervention, the age range is between birth and two years old, and they must qualify for services based on a severity rating. This type of service takes place in a client’s home with parent involvement, and services could continue if necessary once the child is preschool aged. In a preschool setting, clients are aged three to five years old. Clinicians provide push in therapy, along with push out therapy. This means they either are active in the classroom with the client, or the client receives out of classroom care. Other school populations include clients aged five to twenty-one years old. Within a school population, therapists could be treating fifteen to sixty-four students throughout the school year. Because of the large caseloads, therapists tend to have group therapy sessions within the schools to treat as many students as possible. However, if the child requires higher treatment, 1:1 treatment is available (Burke, 2016). To be able to work in these various settings, you need to be ASHA certified and granted a New York State license (Burke, 2016). In order to be an active therapist in an educational institution, you need a New York State teaching certificate. This includes two parts, the initial certificate and the professional certificate. If a therapist only has the TSSLD, they cannot teach curriculum, however, they can work with those who have speech or language problems that affect their academic performance (Burke, 2016). Additionally, a Speech Language Pathologist may have their Certificate of Clinical Competence, which is granted through the Speech Language Hearing Association. Although the Certificate of Clinical Competence is not required, it is strongly recommended for clinicians to acquire. To achieve this certificate, one must finish a Clinical Fellowship year, which is a nine-month paid residency (Burke, 2016). In this week’s observations, we observed Lorene with clinician Karen Copeland and Rebecca with Jennifer Dennis. Each observation exemplifies the variety of populations and settings in speech therapy. Lorene is a 77-year-old female who is diagnosed with mild anomic aphasia and mild apraxia of speech secondary to suffering a left hemisphere CVA in 2010. Clinician Karen Copeland treated Lorene in an inpatient rehabilitation facility. Lorene’s goals included personal goals such as improving her communication skills and mobility, other goals such as improving and increasing the number of information units produced in discourse by 25%, demonstrate 25% decrease in frequency of phonemic paraphrasias over a two-week period, produce effective verbal description of select items in 9/10 trials given extra time, communicate independently during at least one community meal activity with use of self-initiated word finding strategies, be able to state at least three strategies she can use to support her word finding, verbalize increased confidence in her own communication abilities by date of discharge, and lastly verbalize understanding of her communication status and related needs by the date of her discharge (Copeland & Master Clinician Network, 2013). She received 1:1 therapy originally in an acute care facility, but later transferred to a long-term facility in a nursing home. Materials used in this session were techniques used under the Supported Conversation for Adults with Aphasia, Modified PACE activities to promote aphasic communicative effectiveness, and Oral Reading for Language in Aphasia

Rubin 3 program (Copeland & MCN, 2013). The ORLA was used in Lorene’s reevaluation to test her listening comprehension skills. In this task, the clinician read short passages to Lorene, and after reading the passages, she verbally asked Lorene a set of questions that went with the story to evaluate how much she remembered. The ORLA was originally developed in the 1980s to improve reading comprehension in those with aphasia, but has also been used to improve and test the listening comprehension skills of those with aphasia (Mosheim, 2008). The clinician directed approach allowed Ms. Copeland to guide both the initial evaluation and the reevaluation with all that needed to be completed. The clinician used modeling to achieve some of Lorene’s goals. For example, the clinician modeled for Lorene to repeat certain words and phrases, “After you push the button, turn the knob” (Copeland & MCN, 2013). Working on Lorene’s goal of verbalizing understanding of her communication status, the clinician asked Lorene if her language has improved or not. Lorene states that, “I know what I want to say but it does not always come out that way” (Copeland & MCN, 2013). The task that the clinician presented integrated Lorene’s goals and allowed her to speak about her own language skills and how she can improve. Having Lorene transferred to a long-term facility allowed Lorene to increase her success of her goals. Rebecca is a 44-year-old female who was diagnosed with aphasia secondary to suffering a left hemisphere CVA two years prior. Rebecca received 1:1 speech and language therapy with Clinician Jennifer Dennis and the Calvin College Aphasia Center. Rebecca’s goals were to practice word stress, expand verbal expression, practice writing from dictation, and utilize organizational skills to help write a book (Dennis & Master Clinician Network, 2010). This was a clinician directed approach and the clinician prepared tasks prior to the session to aid Rebecca in the intended goals. The clinician provided a task that had Rebecca read complex words on an advertisement that Rebecca was very familiar with. In the task, Rebecca read the advertisement aloud, and any word that she had difficulty with allowed the technician to break down the word into syllables and make them easier for Rebecca to pronounce. For example, the clinician provided the phrase “liquid illuminator,” the clinician broke down each word, liquid to lik-wid and illuminator to il-loom-in-ate-or, to help Rebecca with her pronunciation skills, as well as stress in words (Dennis & MCN, 2010). During the task, the clinician controlled Rebecca’s behavior. When Rebecca was feeling frustrated, the clinician aided in breaking down the word in hopes that outside of the session, Rebecca would be able to break down the word and calm herself down. To practice Rebecca’s listening and comprehension, the clinician set up a task that involved Rebecca to write down inspirational quotes that the clinician said. This allowed Rebecca to focus on what was being read aloud, and practice her comprehension skills. In the Speech Language Pathology field, the many areas in which a therapist could work allows a therapist to move around in different areas of interest within the field. You are allowed freedom to work in many different areas, helping different types of people, and experiencing different situations. Within a therapy session, the materials, methodologies, behavior managements, and therapy approaches combined are extremely vital in the success of the client. The type of setting and the clinician’s credentials and certifications, all aid in the achievement of the client as well. All these techniques combined, and additionally having a good rapport with the client, should make for an enjoyable, effective speech therapy session.

Rubin 4 References Burke, K. (2016). Populations and settings [Video file]. Retrieved from https://bbnewpaltz.sln.suny.edu/bbcswebdav/pid-1743348-dt-content-rid1423961_1/users/burkek/Populations%20and%20Settings/Populations%20and%20Settings.mp4 Burke, K. (2016). Understanding certifications [Video file]. Retrieved from https://bbnewpaltz.sln.suny.edu/webapps/blackboard/content/listContent.jsp? course_id=_92079_1&content_id=_1743347_1 Burke, K. (2016). Goals and methods [Video file]. Retrieved from https://bbnewpaltz.sln.suny.edu/webapps/blackboard/content/listContent.jsp? course_id=_92079_1&content_id=_1743341_1 Copeland, K. (Speech language pathologist) & Master Clinician Network. (2013a). Karen Copeland- Lorene #1 (evaluation). [Video file]. Retrieved from http://masterclinician.org/videos/watch/79426941 Copeland, K. (Speech language pathologist) & Master Clinician Network. (2013b). Karen Copeland- Lorene #2 (evaluation). [Video file]. Retrieved from http://masterclinician.org/videos/watch/79427669 Dennis, J. (Speech language pathologist) & Master Clinician Network. (2010). Jennifer Dennis- Rebecca. [Video file]. Retrieved from http://masterclinician.org/videos/watch/47623874 Mosheim, J. (2008, April 7). Emerging role of technology. Retrieved November 19, 2015, from http://speech-language-pathology-audiology.advanceweb.com/Article/AphasiaTreatment.aspx...