Mohammed were the results? · Does the child’s

Mohammed Almutairi

Scenario #1

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1.    An Overall:
The first scenario involves two siblings who experienced difficult situations
in the past. The brother is 5 ½, and the sister is 4 years old. Firstly, they
were living with their grandfather who committed suicide. Prior the grandfather
passed away due to the suicide, he had attempted unsuccessfully to commit
suicide several times. The grandfather was asking the boy to put the belt
around his neck. The situation has affected the boy’s behaviors. Consequently,
the boy imitates his grandfather by tying things such as cords and strings
around his neck tightly whereas the girl shows inappropriate behavior for her
age such as wetting her pants.  Both
siblings have language delays; in addition to the language delays, the girl
also has articulation delays.

2.    Interview questions:

As an SLP, I will use open-ended
questions during my interview with their mom to gather important information
about their communication skills to include the following questions:

·       When do the problems occur? In what
environments and situations do the problems occur?

·       Why does the client tie things around
his neck? Why does the girl wet her pants?

·       How does the child react to the
problems? How does the child feel about her/his problems?

·       Why do the problems occur? Why is the
child having problems with speech, language, and behaviors?

·       Has he/she been evaluated by an SLP?
Who evaluates him/her? When did the evaluation take place? What did you learn
about the test results?

·       What do you have tried to do to help
him/her?

·        What do you hope will come out of my
evaluation?

·       Does the child seem to understand you?
Others? How well do you underhand the child?

·       Whom does your child interact with
most often? What kinds of activities do they do together?

·       Has the child’s hearing ever been
tested? When? Where? What were the results?

·       Does the child’s participate in
symbolic play?

Open questions are more useful to than
closed questions to encourage the participants to give more responses (Flasher,
2012). Who question provide information about people who are involved in the
situation (Flasher, 2012). Asking “What” questions can give the SLP factual
information or opinions (Flasher, 2012). 
We can also gather information about causes and reasons by asking “Why”
questions (Flasher, 2012).

3.    Listening skills:

Reflection: it
involves reflecting back the last words that the person has said in order to
encourage the individual to say more (Flasher, 2012).  It is as though the SLP is echoing the
individual’s thoughts and the echoing is considered as a prompt (Flasher,
2012). It is important for the SLP to not turn the reflection into questions,
and it can be avoided by providing repetitions in much the same tone of voice
as the individual used (Flasher, 2012). Reflection is helpful to help the
person to say more about the situation, and to give a detailed story. When SLP
uses the reflection strategy, he should consider imply it in a way that sounds
much like normal conversational interaction (Flasher, 2012). 

Selective Reflection:

The listening strategy involves
repeating back to the person a part of what the client said that was emphasized
or being emotionally charged (Flasher, 2012). This strategy allows the SLP to
further access information that was embedded in the individual’s situation
(Flasher, 2012). SLP needs to interject a selective reflection at the moment it
appears most valuable and not wait until there is a break or lull in the
conversation (Flasher, 2012). It is not preferable to use too many selective
reflections to avoid annoying the person (Flasher, 2012).

4.     Microskills & boundaries:

In this
scenario, the clinician can use verbal encouragements as prompt to try to get
more information from the person, such as saying “Hu-huh,” or “Ummmh,” This can
let the clients feel that they are being understood and respected by the
clinician (Flasher,
2012). Additionally, the SLP can use non-verbal encouragers to elicit more
information such as eye contact, nodding the head, smiling, and leering forward
(Flasher, 2012). When SLP integrate verbal and nonverbal encouragers, the
results are more effective to elicit more information during the conversation
(Flasher, 2012). It is essential to avoid using too many encouragers because
they may sound unnatural (Flasher, 2012). Establishing boundaries is important
to determine the type of speech and language services, and to make referral
decision. In this case, it is recommended to have them receiving services from
another specialists such as psychologist, and the SLP will keep following up
with the psychologist about the situation (Flasher, 2012).

5.    Reactions:

The clients have some dangerous
behaviors such as putting the belt around his neck. It is important to provide
them with appropriate preventive intervention by professionals to save their
life.  For example, the mental health
professionals can conduct a systematic suicide evaluation while the SLP can
cooperate with them to provide critical information that may facilitate their
determination of the risk. It is important also to write a detailed report to
explain what the mom or the clients said or did during the interview and your
evaluation. Following up with other professionals is essential to determine
when the clients are ready to receive speech and language pathology services.

6.    Some potential conflicts of interests involving
starting speech and language pathology services immediately for competitive
reasons whereas it is more preferable for me to have the clients receive
services from other clinics, mental centers and professionals before starting
SLP services to save their life.

7.    It is important for SLPs to remember
that we can provide counseling and use counseling skills, but SLPs are not
counselors. So, we should follow our scope of practice and make an appropriate
referral to the right professionals.

8.    I will make a referral to mental
health processionals and psychologists because of their behaviors. I do not
prefer to start the language delay intervention and the articulation therapy
for the girl until I see what psychologists think about the clients.

Scenario #2

1.    Overall: The
second scenario involves a 12-year-old boy who diagnosed with language
delays/disorders plus sensory integration processing. He attends a day program
for troubled youth, he also has been in juvenile detention. He attends the
therapy twice per week. One day, the speech and language pathologist notice an
assault knife under his bike helmet.

2.    Interview questions:

·       Can you tell me how do you feel about
your life?

·       Do you have any problem with someone?
What are you going to do to solve the problem?

·       Are you having any thoughts to harm
your self or other people?

·       Why do you think the reasons some
people carrying assault knife?

·       What are your intentions or plans are?

The reasons for asking these questions
is that SLP allows to ask individuals who make vague references to harm
themselves or others (Flasher, 2012). According to Flasher (2012) asking a
person about possible self-harm does not cause the behaviors, but to be on the
safe side, SLP should ask only general questions rather than brining up the
topic (Flasher, 2012).

3.    Listening skills:

Listening to the client is the most
important step in getting information about the situation. I would use
paraphrasing skill during listening in this scenario to help me to understand
why the client is having an assault knife with him. The aim of paraphrasing is
to assure the client has heard the central meaning of his messages (Flasher,
2012). It also helps the client to keep focusing on a particular area of what
he said (Flasher, 2012). Once the client feels he has been heard, he is often
able to expand on the experiences, providing more information or moving to new
topics (Flasher, 2012).

4.    Microskills:

In this scenario, I will therapist
noises as a microskills. Flasher (2012) is argued that “noises” is used when
SLP does not know quite what to say (or do not want to say what he is really
thinking). By using this microskill, SLP is calling attention to the client’s
words and hoping that the client will examine the behavior or thought in more
depth (Flasher, 2012). “Huhm” is a noise that can lead to a variety of meanings
depending on the context (Flasher, 2012). Psychologists and counselors are
sometimes used the word “sense in place, for instance, “I have a sense that you
are …..”(Flasher, 2012). Setting the processional boundaries is important to
help the client and his family. It is important to make a referral if you
suspect the client is going to harm him or any body else during. SLP can make
the decision of referral during the interview, after asking what’s going on
with the client. It is important to protect the client and other people in this
situation. The SLP will continue planning for health care needs with other
professionals to better serve the client.

5.    Reactions:

I will contact his family, and notify
them about the client, and his behaviors. I will consult the professionals at
the program of troubled youth, and notify them that the client is having an
assault knife, and explains my concerns about him. I will make a referral to
appropriate professionals such as a psychologist. In this case, I would prefer
not to see the client until he receives therapy services from other
professionals such as a psychologist.

6.    Conflicts of interest:

The family may consult the SLP about
the situation after notifying them, and they may also offer fees for the
service. However, SLP should not identify himself as a counselor and get fees
for this service.

7.    Ethical concern:

One
ethical concern can emerge is the need to offer assistance and treatment that
exceeds the level of training and experience. In such a scenario, it is
essential to focus on providing help within one’s scope of knowledge and
arranging additional aid for the child from other professionals who have the
necessary qualifications. Given that it is possible to face additional ethical
concerns that vary in nature, it is important for speech and language
pathologist in this case to always refer to the ASHA code of ethics and obtain
further advice where necessary.

8.     Referral:

Yes,
I will make a referral to a psychologist to assess any behavioral issues or
negative thoughts, and to help the client to improve the client’s quality of
life. I prefer to let the client attends therapy sessions with other
professionals temporally such as a psychologist, until he becomes mentally
ready to receive SLP services.

Scenario
#3

1.    Overall: The
scenario is about a 36 year old male who came for articulation assessment. SLP
notice some articulation problems particularly with /s/ and /z/ sounds, and he
has also wrong placement. The client was not ready for therapy due to anxiety.
SLP notified the client that he needs to wait until his insurance has approved,
in addition, he also needs to wait until the SLP finds an opening spot in the
schedule to take the client. Two weeks later, the client comes to the clinic
before his insurance has approved and also before the SLP gives him a call. The
client is wondering why the SLP does not see him for SLP services.

2.    Interview questions:

1)   
Have
you received a call from our clinic?

2)   
Have
you heard back from your insurance company that your insurance has approved?

3)   
Can
you remind me what we discussed at our last meeting? What were the outcomes of
the meeting?

4)   
How
can I help you?

5)   
Do
you need more clarification about our clinic policy or insurance policy?

6)   
Do
you have any questions for me?

7)   
You
look a little anxious, tell me what is going on with you?

8)   
Do
you need my contact information? So you can call me at any time you need my
help.

9)   
Currently,
I have availability on these days/times; do any of these times work for you? If
not, is it okay for you to wait until I call you back to find a good time to
see you?

I choose some interview questions to elicit information
that can help me to figure out why the client shows up before giving him a
call. It seems that the client did not remember the discussion in our previous
meeting. Thus, I asked questions to know if there is any
misunderstanding/miscommunication happened, or if the client cannot remember
due to pressure and anxiety, or because of mental issues.

3.    Listening skills:

In this scenario, I will use
paraphrasing as a listening skill. The goal of using paraphrasing is to make
sure that the client has accurately heard the meaning of the massages (Flasher,
2012). According to Flasher (2012) paraphrasing is helpful to keep someone
focused on a particular content area. Thus, paraphrasing can help the client to
avoid misunderstanding by repeating the massages more than once. Paraphrasing
is considered as empathic responses to the client’s communications (Flasher,
2012). SLP continue using paraphrasing strategy until the client feels he has
been heard. The clinician needs to avoid adding new content during paraphrasing
(Flasher, 2012).

4.    Microkills:

In this scenario, I will use verbal
encouragers as microskill. According to Flasher (2012) he states that verbal
encouragers are prompts the clinician can use to try to elicit more information
from the client, such as saying “Yes,””Ummm,” or repetition of some words that
the client said (Flasher, 2012). This can help the clinician to know why the
client shows up again before calling him by eliciting more information from
him. It is important to use also nonverbal encouragers such as smiling and eye
contact to let the client feels comfortable, and not to feel bad for showing up
before his insurance has approved. Within boundaries, it is preferable to
provide information about the articulation problems.

5.    Reactions:

Anxiety is a common component of many
communication problems, and it can affect many major areas of communication
(Flasher, 2012). Thus, individuals who are anxious can show misunderstanding
and inappropriate behaviors. Thus, I will clarify again for the client that he
needs to wait until we hear back from the insurance company. I will show the
client my schedule, and explain to him that I do not have available time to fit
him into my busy schedule, and once we find availability; the clinician will
give him a call. If the client has any other problems not related to speech and
language, the SLP will make a referral to an appropriate professional. Finally,
the SLP will ask the client to repeat what we discussed in the meeting to make
sure he understood everything, and give him a reminder note.

6.    Conflicts of interest:

SLP should avoid making any diagnosis
about the client’s situation before conducing full assessment. The interview
questions that we asked during this scenario are not enough to make judgments
about the client. Some SLPs may start therapy as soon as possible after the
initial meeting to get paid. According to ASHA (2017) An SLP belief that his or
her professional judgment is unaffected by economic benefits.

7.    Passible ethical concerns:

The client may request a service
outside our scope of practice such as treatment for his anxiety. It is
important for the SLP to offer services that are only within our scope of
practice, and ask for assistance from other professionals who are capable to
provide such treatments.

8.    If the client continues having
anxiety, it is recommended to make a referral to psychiatrist to treat his
anxiety. Yes, I will continue seeing him.

Scenario #4

1. Overall:

The scenario is about a 4 year-old girl who has had
skills and language regression due to epilepsy. The assessment indicates
language delay that may turn to be a disorder because of the repeated seizures
with average 100 petite per day. 
Recently, the client shows an appropriate behavior such as defecating
herself, and drawing a male anatomy on Dora instead of identifying colors. The
mom seems stressed whereas the dad always looks happy.

2. Interview questions:

Interviewing can be considered an interactive process for
eliciting information about the client’s situation. I asked questions to better
understand the effectiveness portents-child interaction, and to know if there
is any problem that influences the client’s life.

– Do you follow up with a neurologist regularly for
seizure treatment and evaluation?

– What have you done to help her to improve her
communication skills?

– You look stressed out lately; tell what is going on
with you?

– Is there anything that you think I should know about
the client?

– How can you describe the relationship between your
daughter and her dad and mom?

– Why do you think the client starts defecating herself?
What are the dad and mom reactions to this behavior?

– Why the client likes to draw a male anatomy?

– What do you parents do when they cannot understand her?

– Where does she like to spend her time when you are at
home?

– Who likes to play with her the most when she is home?

3. Listening skills:

In the fourth scenario, I will use a reflection of
feeling skill. It involves paraphrasing responses of a feeling communicated by
the client verbally or nonverbally (Flasher, 2012). When we reflect feelings,
we try to identify affective or feeling words that are in tune with the
parent’s emotional experience (Flasher, 2012). By using a reflection of
feeling, the SLP can indicate that he has understood the feeling the
parent/client is experiencing and why she is stressed out by providing a
statement (Flasher, 2012). Therefore, the SLP should be alert to the affective
state of what the person said (Flasher, 2012). To use the reflection of
feeling, SLP can use include the person’s name and the pronoun ” you” for
instance ” it looks like you are stressed out …” (Flasher, 2012). Finally, it
is important to understand not only the feelings but also the strength of the
feelings, and its affect (Flasher, 2012).

4. Microskills:

– Questioning: It is a helpful micro skill to guide
the counseling conversation. I SLP can use questioning to eliciting useful
information during the interview. For instance, the SLP can ask, ” Why you are stressed
out today?”

– Focusing: is a useful skill that enables the
SLP to direct the conversation to a specific focus. For instance, if the mom
gives a little information about why the girls show inappropriate behaviors,
the SLP can direct the conversation to elicit more information about that
behaviors. Within boundaries, it is useful to support the strengths of the
client and her family to help them to interacts effectively.

5. Reactions:

I will provide the client with early intervention to
prevent language delay to be language disorders, and to minimize the risk
factors associated with the language delay. I also will engage the family (dad
and mom) in therapy sessions, and encourage the positive interaction between
the parents and their child. I will teach the parents how important to have a
good environment at home to improve her communication and behavior skills. I let
the parents know that I am ready to help them if they need any additional
consultations form me or other professionals.

6. Conflicts of
interest:

For instance, owning the SLP clinic that sells treatment
tools to the client can be a conflict of interest.

7. Passible ethical
concerns:

One
ethical issue that is likely to occur in the speech therapy process of the
child regards the amount and type of service she needs. It is possible for the
SLP to have conflicting views with the parents about the sort of help that the
child requires. In such instances, it is essential to consult the American
Speech-Language-Hearing Association (ASHA) code of ethics and use them as a
guide to inform actions that follow (Lubinski & Hudson, 2013).

8.Referral:

I may make a referral to psychiatric for treating
abnormal behaviors. Another referral for a family therapist can be useful to
improve the interaction among family’s members. SLP will continue seeing the
client.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

 

Flasher, L. and P. Fogle (2012).
Counseling skills for speech-language pathologists and audiologists. Clifton
Park, NY, USA, Delmar Cengage Language

 

 

 

 

 

 

 

 

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