The Acquisition of Static and Dynamic Intervention Skills by Graduate Speech-Language Pathology Students.

PURPOSE: Speech-language pathology programs use simulated learning experiences (SLEs) to teach graduate student clinicians about fidelity to therapeutic interventions, including static skills (clinical actions that are delivered in a prespecified way regardless of the client's behavior) and dynamic skills (contingent responses formulated in response to a client's behavior). The purpose of this study was to explore student learning of static and dynamic skills throughout SLEs and live clinical practice. METHOD: Thirty-three speech-language pathology graduate students participated in this study. Students were first trained to deliver an intervention before having their treatment fidelity measured at three time points: an initial SLE, actual clinical practice, and a final SLE. Treatment fidelity was first summarized using an overall accuracy score and then separated by static and dynamic skills. We hypothesized that (a) overall accuracy would increase from the initial simulation to treatment but remain steady from treatment to the final simulation and that (b) students would acquire dynamic skills more slowly than static skills. RESULTS: In line with our hypotheses, students' overall accuracy improved over time. Although accuracy for static skills was mostly established after the first simulation, dynamic skills remained less accurate, with a slower acquisition timeline. CONCLUSIONS: These results demonstrate that SLEs are efficacious in teaching students the clinical skills needed for actual clinical practice. Furthermore, we show that dynamic skills are more difficult for students to learn and implement than static skills, which suggests the need for greater attention to dynamic skill acquisition during clinical education.

The Impact of Treating Bilingual Clients on Speech-Language Pathology Students' Cultural Responsiveness.

PURPOSE: Graduate programs often use practicum experience with clients from nonmajority cultures to improve students' cultural responsiveness. Yet, it is not clear whether simply working with a client from a nonmajority culture actually confers this benefit or whether students are thinking about how to include culturally responsive behaviors when they are considering how to address a clinical case. METHOD: Twenty first-year speech-language pathology graduate students (10 Spanish-English bilinguals, 10 monolingual English speakers) were split into three groups: monolingual experimental (n = 4), bilingual experimental (n = 4), and control (n = 12). The experimental groups completed a structured practicum with bilingual Hispanic/Latino clients. They received a 1-hr training in cultural responsiveness and then implemented a systematic language intervention in English or Spanish. Changes to cultural responsiveness were measured via think-aloud cases, and changes to confidence were measured with published, self-report scales. Reflective journal entries revealed what aspects of the clinical practicum students found most salient. RESULTS: Experience working with bilingual clients did not have a substantial effect on students' confidence in their cultural competence. No substantial change was found in cultural responsiveness on the think-aloud for any group. Cultural responsiveness did not appear to be top-of-mind for the students. CONCLUSIONS: Simply working with clients from nonmajority cultures does not create a scenario where cultural responsiveness is likely to improve. Additional targeted, purposeful training in cultural responsiveness is necessary.

How does training format and clinical education model impact fidelity and confidence in a speech-language pathology rotation?

Clinical education rotations typically involve an initial training phase followed by supervised clinical practice. However, little research has explored the separate contributions of each component to the development of student confidence and treatment fidelity. The dual purpose of this study was to compare the impact of clinical training format (synchronous vs. asynchronous) and education model (traditional vs. collaborative) on student confidence and treatment fidelity. Thirty-six speech-language pathology graduate students completed this two-phase study during a one-term clinical rotation. Phase 1 investigated the impact of training condition (synchronous, asynchronous guided, asynchronous unguided) on student confidence and treatment fidelity. Phase 2 explored the impact of education model (traditional vs. collaborative) on student confidence and treatment fidelity. Treatment fidelity was measured at the conclusion of Phases 1 and 2. Students rated their confidence at six-time points throughout the study. Our results indicate that training condition did not differentially impact student confidence or treatment fidelity; however, education model did: students in the collaborative education model reported increased confidence compared to students in the traditional education model. Students in the collaborative education model also trended towards having higher treatment fidelity than students in the traditional education model. These results demonstrate that pre-clinical trainings can be effective in several different formats provided they cover the discrete skills needed for the clinical rotation. While preliminary, our results further suggest that students may benefit from working with peers during their clinical rotations.

What Is Clinical Evidence in Speech-Language Pathology? A Scoping Review.

PURPOSE: Two disparate models drive American speech-language pathologists' views of evidence-based practice (EBP): the American Speech-Language-Hearing Association's (2004a, 2004b) and Dollaghan's (2007). These models discuss evidence derived from clinical practice but differ in the terms used, the definitions, and discussions of its role. These concepts, which we unify as clinical evidence, are an important part of EBP but lack consistent terminology and clear definitions in the literature. Our objective was to identify how clinical evidence is described in the field. METHOD: We conducted a scoping review to identify terms ascribed to clinical evidence and their descriptions. We searched the peer-reviewed, accessible, speech-language pathology intervention literature from 2005 to 2020. We extracted the terms and descriptions, from which three types of clinical evidence arose. We then used an open-coding framework to categorize positive and negative descriptions of clinical expertise and summarize the role of clinical evidence in decision making. RESULTS: Seventy-eight articles included a description of clinical evidence. Across publications, a single term was used to describe disparate concepts, and the same concept was given different terms, yet the concepts that authors described clustered into three categories: clinical opinion, clinical expertise, and practice-based evidence, with each described as distinct from research evidence, and separate from the process of clinical decision making. Clinical opinion and clinical expertise were intrinsic to the clinician. Clinical opinion was insufficient and biased, whereas clinical expertise was a positive multidimensional construct. Practice-based evidence was extrinsic to the clinician-the local clinical data that clinicians generated. Good clinical decisions integrated multiple sources of evidence. CONCLUSIONS: These results outline a shared language for SLPs to discuss their clinical evidence with researchers, families, allied professionals, and each other. Clarification of the terminology, associated definitions, and the contributions of clinical evidence to good clinical decision-making informs EBP models in speech-language pathology. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21498546.

A Mathematical Model Captures the Structure of Subjective Affect.

Although it is possible to observe when another person is having an emotional moment, we also derive information about the affective states of others from what they tell us they are feeling. In an effort to distill the complexity of affective experience, psychologists routinely focus on a simplified subset of subjective rating scales (i.e., dimensions) that capture considerable variability in reported affect: reported valence (i.e., how good or bad?) and reported arousal (e.g., how strong is the emotion you are feeling?). Still, existing theoretical approaches address the basic organization and measurement of these affective dimensions differently. Some approaches organize affect around the dimensions of bipolar valence and arousal (e.g., the circumplex model), whereas alternative approaches organize affect around the dimensions of unipolar positivity and unipolar negativity (e.g., the bivariate evaluative model). In this report, we (a) replicate the data structure observed when collected according to the two approaches described above, and reinterpret these data to suggest that the relationship between each pair of affective dimensions is conditional on valence ambiguity, and (b) formalize this structure with a mathematical model depicting a valence ambiguity dimension that decreases in range as arousal decreases (a triangle). This model captures variability in affective ratings better than alternative approaches, increasing variance explained from ~60% to over 90% without adding parameters.

A Randomized Implementation Study of Trauma-Focused Cognitive Behavioral Therapy for Adjudicated Teens in Residential Treatment Facilities.

Adjudicated youth in residential treatment facilities (RTFs) have high rates of trauma exposure and post-traumatic stress disorder (PTSD). This study evaluated strategies for implementing trauma-focused cognitive behavioral therapy (TF-CBT) in RTF. Therapists (N = 129) treating adjudicated youth were randomized by RTF program (N = 18) to receive one of the two TF-CBT implementation strategies: (1) web-based TF-CBT training + consultation (W) or (2) W + 2 day live TF-CBT workshop + twice monthly phone consultation (W + L). Youth trauma screening and PTSD symptoms were assessed via online dashboard data entry using the University of California at Los Angeles PTSD Reaction Index. Youth depressive symptoms were assessed with the Mood and Feelings Questionnaire-Short Version. Outcomes were therapist screening; TF-CBT engagement, completion, and fidelity; and youth improvement in PTSD and depressive symptoms. The W + L condition resulted in significantly more therapists conducting trauma screening (p = .0005), completing treatment (p = .03), and completing TF-CBT with fidelity (p = .001) than the W condition. Therapist licensure significantly impacted several outcomes. Adjudicated RTF youth receiving TF-CBT across conditions experienced statistically and clinically significant improvement in PTSD (p = .001) and depressive (p = .018) symptoms. W + L is generally superior to W for implementing TF-CBT in RTF. TF-CBT is effective for improving trauma-related symptoms in adjudicated RTF youth. Implementation barriers are discussed.

Brain systems involved in arithmetic with positive versus negative numbers.

Positive number arithmetic is based on combining and separating sets of items, with systematic differences in brain activity in specific regions depending on operation. In contrast, arithmetic with negative numbers involves manipulating abstract values worth less than zero, possibly involving different operation-activity relationships in these regions. Use of procedural arithmetic knowledge, including transformative rules like "minus a negative is plus a positive," may also differ by operand sign. Here, we examined whether the activity evoked in negative number arithmetic was similar to that seen in positive problems, using region of interest analyses (ROIs) to examine a specific set of brain regions. Negative-operand problems demonstrated a positive-like effect of operation in the inferior parietal lobule with more activity for subtraction than addition, as well as increased activity across operation. Interestingly, while positive-operand problems demonstrated the expected addition > subtraction activity difference in the angular gyrus, negative problems showed a reversed effect, with relatively more activity for subtraction than addition. Negative subtraction problems may be understood after translation to addition via rule, thereby invoking more addition-like activity. Whole-brain analyses showed increased right caudate activity for negative-operand problems across operation, indicating a possible overall increase in usage of procedural rules. Arithmetic with negative numbers may thus shows some operation-activity relationships similar to positive numbers, but may also be affected by strategy. This study examines the flexibility of the mental number system by exploring to what degree the processing of an applied usage of a difficult, abstract mathematical concept is similar to that for positive numbers.

Innovations in Practice: Dissemination and implementation of child-parent psychotherapy in rural public health agencies.

BACKGROUND: Early trauma exposure can have long-term negative health effects. Few young children receive evidence-based trauma treatment. This article explores the feasibility of implementing Child-Parent Psychotherapy (CPP), an evidence-based intervention, in rural public health agencies. METHOD: Twenty-three clinicians across four agencies were trained. Training outcomes and implementation barriers and facilitators were assessed. RESULTS: One hundred twelve client-caregiver dyads began the year-long treatment; 50% are currently enrolled or have completed treatment. Barriers and facilitators to implementation were identified. CONCLUSIONS: CPP is feasible to implement in rural community mental health agencies. Important lessons were learned related to planning, implementation, and sustainability.

Understanding less than nothing: children's neural response to negative numbers shifts across age and accuracy.

We examined the brain activity underlying the development of our understanding of negative numbers, which are amounts lacking direct physical counterparts. Children performed a paired comparison task with positive and negative numbers during an fMRI session. As previously shown in adults, both pre-instruction fifth-graders and post-instruction seventh-graders demonstrated typical behavioral and neural distance effects to negative numbers, where response times and parietal and frontal activity increased as comparison distance decreased. We then determined the factors impacting the distance effect in each age group. Behaviorally, the fifth-grader distance effect for negatives was significantly predicted only by positive comparison accuracy, indicating that children who were generally better at working with numbers were better at comparing negatives. In seventh-graders, negative number comparison accuracy significantly predicted their negative number distance effect, indicating that children who were better at working with negative numbers demonstrated a more typical distance effect. Across children, as age increased, the negative number distance effect increased in the bilateral IPS and decreased frontally, indicating a frontoparietal shift consistent with previous numerical development literature. In contrast, as negative comparison task accuracy increased, the parietal distance effect increased in the left IPS and decreased in the right, possibly indicating a change from an approximate understanding of negatives' values to a more exact, precise representation (particularly supported by the left IPS) with increasing expertise. These shifts separately indicate the effects of increasing maturity generally in numeric processing and specifically in negative number understanding.

Costs of a public health model to increase receipt of hepatitis-related services for persons with mental illness.

OBJECTIVE: This study examined the costs and impact on receipt of hepatitis and HIV testing and hepatitis immunization services of a public health intervention model that was designed for use by persons with serious mental illness and co-occurring substance use disorders. METHODS: Between 2006 and 2008, a random sample of 202 nonelderly, predominantly African-American males with a psychotic or major depressive disorder and a co-occurring substance use disorder was recruited at four community mental health outpatient programs in a large metropolitan area. Participants were randomly assigned at each site to enhanced treatment as usual (N=97), including education about blood-borne diseases and referrals for testing and vaccinations, or to an experimental intervention (N=105) that provided on-site infectious disease education, screening of risk level, pretest counseling, testing for HIV and hepatitis B and C, vaccination for hepatitis A and B, and personalized risk-reduction counseling. The authors compared the two study groups to assess the average costs of improving hepatitis and HIV testing and hepatitis A and B vaccination in this population. RESULTS: The average cost per participant was $423 for the intervention and $24 for the comparison condition (t=52.7, df=201, p<.001). The costs per additional person tested was $706 for hepatitis C, $776 for hepatitis B, and $3,630 for HIV, and the cost per additional person vaccinated for hepatitis was $561. CONCLUSIONS: Delivery of hepatitis and HIV public health services to persons with serious mental illness in outpatient mental health settings can be as cost-effective as similar interventions for other at-risk populations.

Cognitive decline and older adults' perception of stigma controllability.

Emerging research suggests that older adults who experience age-related declines in regulatory abilities may have more difficulty inhibiting their expression of negative bias to stigmatized individuals as compared with young adults. However, it remains largely unexplored why this might be. For instance, older adults may hold stigmatized individuals more accountable for their conditions as compared with young adults, which could subsequently increase their expression of negative bias. The current study investigated this question by testing 90 older adults and 44 young adults. Researchers found that older adults with relatively impaired executive function placed a greater emphasis on controllability when evaluating stigmatized individuals and rated the stigmatized conditions overall as being more changeable.

Physical experience leads to enhanced object perception in parietal cortex: insights from knot tying.

What does it mean to "know" what an object is? Viewing objects from different categories (e.g., tools vs. animals) engages distinct brain regions, but it is unclear whether these differences reflect object categories themselves or the tendency to interact differently with objects from different categories (grasping tools, not animals). Here we test how the brain constructs representations of objects that one learns to name or physically manipulate. Participants learned to name or tie different knots and brain activity was measured whilst performing a perceptual discrimination task with these knots before and after training. Activation in anterior intraparietal sulcus, a region involved in object manipulation, was specifically engaged when participants viewed knots they learned to tie. This suggests that object knowledge is linked to sensorimotor experience and its associated neural systems for object manipulation. Findings are consistent with a theory of embodiment in which there can be clear overlap in brain systems that support conceptual knowledge and control of object manipulation.

Understanding less than nothing: neural distance effects for negative numbers.

Little work has examined how the mental number system accommodates counterintuitive quantities such as negative numbers, which seem to extend the left end of the mental number line and reverse the established relationship between digit magnitude and value; even less research has been conducted on the neural systems supporting negative number understanding. This study aimed to determine whether adult behavioral and neural responses to negative number paired comparisons were similar to those expected for positive numbers. Mixed pairs (with one positive and one negative number) were also included. Negative number responses demonstrated an increased typical distance effect relative to that for positives, with decreasing response times and intraparietal sulcus activity for comparisons farther apart than those closer together. Negative pairs also showed more activity than positive comparisons across distances in the occipital lobe, inferior and superior parietal lobule, and bilateral caudate and putamen. Mixed pair effect direction varied based on polarity sensitivity, or whether attention to the negative sign was needed for accurate responses, indicating differences in processing strategy. Adults thus draw on brain areas important in numeric processing when dealing with negatives, but also recruit further areas and strategies to support the unique features of negative numbers. The increased distance effect seen may reflect a less mature understanding of negatives. This work expands our knowledge of the flexibility of the mental number system and its ability to represent difficult quantities.

The strategic nature of false recognition in the DRM paradigm.

The false memory effect produced by the Deese/Roediger & McDermott (DRM) paradigm is reportedly impervious to warnings to avoid false alarming to the critical lures (D. A. Gallo, H. L. Roediger III, & K. B. McDermott, 2001). This finding has been used as strong evidence against models that attribute the false alarms to a decision process (e.g., M. B. Miller & G. L. Wolford, 1999). In this report, the authors clarify their earlier article and suggest that subjects establish only 2 underlying criteria for a recognition judgment, a liberal criterion for items that seem to be related to 1 of the study list themes and a conservative criterion for items that do not seem to be related. They demonstrate that warnings designed on the basis of these underlying criteria are effective in significantly suppressing the false recognition effect, suggesting that strategic control of the retrieval response does play a role in the DRM paradigm.

Assessing the STIRR model of best practices for blood-borne infections of clients with severe mental illness.

OBJECTIVES: People with co-occurring severe mental illness and a substance use disorder are at markedly elevated risk of infection from HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV), but they generally do not receive basic recommended screening or preventive and treatment services. Barriers to services include lack of programs offered by mental health providers and client refusal of available services. Clients from racial-ethnic minority groups are even less likely to accept recommended services. The intervention tested was designed to facilitate integrated infectious disease programming in mental health settings and to increase acceptance of such services among clients. METHODS: A randomized controlled trial (N=236) compared enhanced treatment as usual (control) with a brief intervention to deliver best-practice services for blood-borne diseases in an urban sample of clients with co-occurring disorders who were largely from racial-ethnic minority groups. The "STIRR" intervention included Screening for HIV and HCV risk factors, Testing for HIV and hepatitis, Immunization against hepatitis A and B, Risk reduction counseling, and medical treatment Referral and support at the site of mental health care. RESULTS: Clients randomly assigned to the STIRR intervention had high levels (over 80%) of participation and acceptance of core services. They were more likely to be tested for HBV and HCV, to be immunized against hepatitis A virus and HBV, and to increase their knowledge about hepatitis and reduce their substance abuse. However, they showed no reduction in risk behavior, were no more likely to be referred to care, and showed no increase in HIV knowledge. Intervention costs were $541 per client (including $234 for blood tests). CONCLUSIONS: STIRR appears to be efficacious in providing a basic, best-practice package of interventions for clients with co-occurring disorders.

Contorted and ordinary body postures in the human brain.

Social interaction and comprehension of non-verbal behaviour requires a representation of people's bodies. Research into the neural underpinnings of body representation implicates several brain regions including extrastriate and fusiform body areas (EBA and FBA), superior temporal sulcus (STS), inferior frontal gyrus (IFG) and inferior parietal lobule (IPL). The different roles played by these regions in parsing familiar and unfamiliar body postures remain unclear. We examined the responses of this body observation network to static images of ordinary and contorted postures by using a repetition suppression design in functional neuroimaging. Participants were scanned whilst observing static images of a contortionist or a group of objects in either ordinary or unusual configurations, presented from different viewpoints. Greater activity emerged in EBA and FBA when participants viewed contorted compared to ordinary body postures. Repeated presentation of the same posture from different viewpoints lead to suppressed responses in the fusiform gyrus as well as three regions that are characteristically activated by observing moving bodies, namely STS, IFG and IPL. These four regions did not distinguish the image viewpoint or the plausibility of the posture. Together, these data define a broad cortical network for processing static body postures, including regions classically associated with action observation.

Unique and persistent individual patterns of brain activity across different memory retrieval tasks.

Fourteen subjects were scanned in two fMRI sessions separated by several months. During each session, subjects performed an episodic retrieval task, a semantic retrieval task, and a working memory task. We found that 1) despite extensive intersubject variability in the pattern of activity across the whole brain, individual activity patterns were stable over time, 2) activity patterns of the same individual performing different tasks were more similar than activity patterns of different individuals performing the same task, and 3) that individual differences in decision criterion on a recognition test predicted the degree of similarity between any two individuals' patterns of brain activity, but individual differences in memory accuracy or similarity in structural anatomy did not. These results imply that the exclusive use of group maps may be ineffective in profiling the pattern of activations for a given task. This may be particularly true for a task like episodic retrieval, which is relatively strategic and can involve widely distributed specialized processes that are peripheral to the actual retrieval of stored information. Further, these processes may be differentially engaged depending on individual differences in cognitive processing and/or physiology.

The principled control of false positives in neuroimaging.

An incredible amount of data is generated in the course of a functional neuroimaging experiment. The quantity of data gives us improved temporal and spatial resolution with which to evaluate our results. It also creates a staggering multiple testing problem. A number of methods have been created that address the multiple testing problem in neuroimaging in a principled fashion. These methods place limits on either the familywise error rate (FWER) or the false discovery rate (FDR) of the results. These principled approaches are well established in the literature and are known to properly limit the amount of false positives across the whole brain. However, a minority of papers are still published every month using methods that are improperly corrected for the number of tests conducted. These latter methods place limits on the voxelwise probability of a false positive and yield no information on the global rate of false positives in the results. In this commentary, we argue in favor of a principled approach to the multiple testing problem--one that places appropriate limits on the rate of false positives across the whole brain gives readers the information they need to properly evaluate the results.

Medial temporal lobe BOLD activity at rest predicts individual differences in memory ability in healthy young adults.

Human beings differ in their ability to form and retrieve lasting long-term memories. To explore the source of these individual differences, we used functional magnetic resonance imaging to measure blood-oxygen-level-dependent (BOLD) activity in healthy young adults (n = 50) during periods of resting fixation that were interleaved with periods of simple cognitive tasks. We report that medial temporal lobe BOLD activity during periods of rest predicts individual differences in memory ability. Specifically, individuals who exhibited greater magnitudes of task-induced deactivations in medial temporal lobe BOLD signal (as compared to periods of rest) demonstrated superior memory during offline testing. This relationship was independent of differences in general cognitive function and persisted across different control tasks (i.e., number judgment versus checkerboard detection) and experimental designs (i.e., blocked versus event-related). These results offer a neurophysiological basis for the variability in mnemonic ability that is present amongst healthy young adults and may help to guide strategies aimed at early detection and intervention of neurological and mnemonic impairment.

Evaluations of pleasurable experiences: the peak-end rule.

Prior research suggests that the addition of mild pain to an aversive event may lead people to prefer and directly choose more pain over less pain (Kahneman, Fredrickson, Schreiber, & Redelmeier, 1993). Kahneman et al. suggest that pain ratings are based on a combination of peak pain and final pain. Similarly, people rate a happy life that ends suddenly as being better than one with additional years of mild happiness (Diener, Wirtz, & Oishi, 2001), even though the former objectively consists of less pleasure than the latter. Applying these concepts to material goods, we investigated the impact of positivity and timing on the retrospective evaluations of material goods. We found strong evidence that the peak-end rule applies to both material goods and pain.