AN SLP ONCE TRIED TO TEST ME Making use of dynamic assessment, counseling strategies, medical history, and the interdisciplinary team for effective patient advocacy and treatment Will Farnham, MS CCC - SLP FUTURE COLLEAGUE COLLAB MAY 6, 2020
OPEN KIMONO Financial disclosures MedSLP Collective Af f iliate (receive commissions, access) Full-time employee of Dysphagia Management Systems Earn pro f its from merchandise sales on my website/social media; media used herein Non- f inancial disclosures Appeared once on the ORION PICTURES Speech Uncensored Podcast
QUID PRO QUO, CLARICE Objectives/Learner Outcomes • • Describe the role of building a Describe the role of SLP scope of thorough and accurate patient practice as relates to history in adverse circumstances interdisciplinary consultation • • Describe barriers to standard Describe relevant ethical assessment administration and imperatives with respect to advantages/disadvantages of diagnostic, therapeutic, and alternatives interdisciplinary care • Describe the role of counseling strategies in post-acute adult rehab SLP intervention
NETFLIX WITH SOME FAVA BEANS AND A NICE H&P
MEDICAL HISTORY BARRIERS Incomplete/delayed records transfers (Kind et. al 2011) Rashomon -style historians Limited patient/caregiver knowledge/insight Systemic implementation of the medical model Chief complaints vs unaddressed comorbidities
WHAT CAN YOU DO ABOUT IT?
OVERCOMING HX BARRIERS Keep checking the chart Develop relationships at the prior levels of care
THE P IN HIPAA IS FOR PORTABILITY, NOT PRIVACY
OVERCOMING HX BARRIERS Keep checking the chart Develop relationships at the prior levels of care Get as many historical perspectives as possible Scrutinize the med list Look at home meds vs current meds What’s the same, what’s new, what’s been stopped?
BERNIE SANDERS CAMPAIGN IT PUTS THE CLOCK FACE ON THE PAGE
BARRIERS TO STANDARD ASSESSMENT Institutional barriers Standardization barriers Time constraints Impairment severity Patient acceptability
WHAT CAN YOU DO ABOUT IT?
OVERCOMING ASSESSMENT BARRIERS Doggedly advocate Spend your own money K.I.S.S.—Keep It Short, Speechie Patient Reported Outcome Measures Focus on function vs impairment Be comfortable with temporary uncertainty
THE BEST ASSESSMENT IS THE ONE THE PATIENT WILL COMPLETE* *USUALLY
HIS THERAPY WAS GOING NOWHERE
RUDIMENTS OF COUNSELING Unconditional positive clinical regard Assumed competence Active listening Self-sharing Nonjudgmentalism Nondirective interviewing
COUNSELING AS DYNAMIC ASSESSMENT Counseling can feel “unproductive” Can increase patient buy-in Frequently helps to establish or entrench rapport Can increase agreeability to increased structure and complexity Patients who are comfortable sharing will share novel information relevant to history Open-ended expression reveals functional data about recall and executive function
I DO WISH WE COULD CHAT LONGER, BUT I’M HAVING AN OLD FRIEND FOR DINNER
YOUR SCOPE AND THE IDT Have con f idence in your scope of practice Both general scope and also personal specializations Boundaries convey novel liberties
KNOW YOUR GROUND SO YOU CAN STAND YOUR GROUND
YOUR SCOPE AND THE IDT Have con f idence in your scope of practice Both general scope and also personal specializations Boundaries convey novel liberties Know your ground so you can stand your ground Have con f idence in your knowledge of the case Be clear about the things you don’t know Does the patient have gaps in their history and active diagnoses?
INDIVIDUALS SHALL HONOR THEIR RESPONSIBILITY TO HOLD PARAMOUNT THE WELFARE OF PERSONS THEY SERVE PROFESSIONALLY… ASHA Code of Ethics: Principles of Ethics I
INDIVIDUALS SHALL UPHOLD THE DIGNITY AND AUTONOMY OF THE PROFESSIONS, MAINTAIN COLLABORATIVE AND HARMONIOUS INTERPROFESSIONAL AND INTRAPROFESSIONAL RELATIONSHIPS, AND ACCEPT THE PROFESSIONS' SELF - IMPOSED STANDARDS. ASHA Code of Ethics: Principles of Ethics IV
YOUR SCOPE AND THE IDT CONSIDERATIONS FROM THE ASHA CODE OF ETHICS Principle IV, Rule A: “Individuals shall work collaboratively, when appropriate, with members of one's own profession and/or members of other professions to deliver the highest quality of care.” Principle I, Rule B: “Individuals shall use every resource, including referral and/or interprofessional collaboration when appropriate, to ensure that quality service is provided.” Principle II, Rule A: “Individuals who hold the Certi f icate of Clinical Competence shall engage in only those aspects of the professions that are within the scope of their professional practice and competence, considering their certi f ication status, education, training, and experience.”
FLY, FLY, FLY , CLARICE Thanks for being here; Check out the case
FARNHAM IS VERY CLEVER, ISN’T HE, USING YOU? Thanks and apologies Thanks Apologies • Leigh Ann Porter/ • Net f lix, Adam Driver Speech Uncensored • Orion Pictures, Ted Tally, • Theresa Richard and Thomas Harris • Bernie Sanders Campaign FAIR USE IS A HECK OF A THING
CONTACT INFO Like you’d want to do that email: williamfarnham@gmail.com memes IG: @hardtoswallowslp ethics/philosophy IG: @slpworldview
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