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IntroCommTest2

QuestionAnswer
Define genetics the study of heredity and how traits are passed on through generations
Genetics is the study of _____ and how ____ are passed on through generations heredity; traits
What are our bodies made up of? trillions of cells
Each cell has a ____ nucleus
which part of the cell contains genetic material? the nucleus
What does the nucleus of the cell contain? genetic material
What is the genetic code like? an instrument manual that tells our body how to develop and function
explain how the nucleus of the cell is the control center it houses our DNA
What factors does genetics study? DNA, genes, chromosomes
What does DNA contain? 23 sets of chromosomes (1 set from each parent)
What are considered letters that carry genetic information the 23 sets of chromosomes
What is a biological unit of inheritance denes
where are genes located on a chromosome
genes are considered _____ and DNA is compared to ______ sentences; letters
genes are a biological unit of _____ inheritance
where are chromosomes located? in the nuclues of the cell
functions in the transmission of genetic information chromosomes
chromosomes are compared to ______ chapters
chemical letters that instruct our bodies DNA
the DNA letters include: A, C, T, G
each chromosome contains many _____, or sentences genes
what do genes tell the cells how to perform a different function
give an example of what a gene may tell the cells make protein
_____ perform the functions of the body proteins
give an example of how proteins perform the functions of the body to carry oxygen in the blood, or protect the lungs from pollutants
Proteins also form _____, such as ___ or muscle structures, collegen
another term for changed mutated
what happens to a gene when it is mutated the structure and/or function of the gene and its protein can be disrupted of altered
What is like adding extra words to a sentance or erasing parts of words so that the sentence no longer makes sense when genes are changed
We have a total of ___chromosomes (___ pairs) 46; 23
we can line the chromosomes up in a ________ picture karyotype
different _______ (chapters) contain different ______(sentences) chromosomes; genes
what do different chromosomes comtain different genes
Each _____ directs a different function(s) in the body, or help produce a different structure gene
what does each gene direct a different function in the body
what does each gene help produce a different structure
2 things a gene can do 1-direct a different function(s) or 2-help produce a different structure
what can looking at chromosomes tell us changes in a single gene on a chromosome, changes in the total # of chromosomes, changes in the structure of chromosomes
how can we tell changes in a single gene, in the total #, and structure of a chromosome by looking at the chromosomes
the ______ is considered a bookshelf nuclues
why is the nucleus considered a bookshelf because it contains the genetic instruction book
_____ is the genetic material DNA
____ are sentences, made with the letters of ____, that build the chapters in the book genes, DNA
what makes up the DNA genes
explain how the cell could form a story when relating genes, DNA, and chromosomes the chromosomes are the chapters which are made of the sentences of genes which are broken down into the letters of DNA
what are compared to the chapters in the book chromosomes
how are traits determined by the interplay of a variety of genes
____ are determined by the interplay of a variety of genes traits
what are 2 types of genes involed in the growth and development of an embryo structural and regulatory
how are structural and regulatory genes involved with an embryo in the growth and development
structural genes directly affect the _____ and ___ of specific body parts growth and development
kinds of tissue or metabolic functions are _____ _____ structural genes
give an example of structural genes bones in the hand or eye color
what do regulatory genes do they supervise the expression of genes and influence how other genes are expressed
regulatory genes ____ the expression of genes and ____ how other genes are expressed supervise, influence
Which type of gene may have more of a widespread effect during the development of an embryo regulatory genes
what 2 types of influence can a gene have direct or indirect
down syndrome is an example of what a direct effect of a gene
direct effect is seen when a particular gene causes what? a disorder or anomaly in an embryo
Pierre Robin syndrome is an example of what an indirect effect of a gene
an indirect effect is a problem or abnormality that results from what secondarily from a genetic error, which results from a cascading effect
what is a syndrome a complex of signs and symptoms resulting from a common etiology or appearing together that represents a clinical picture of a disease or inherited anomaly
syndrome is a complex of ____ and ____ resulting from a common etiology signs; symptoms
what is the difference of a sign and a symptom sign: an objective finding or a disease; symptom: a subjective finding of a disease
Mendelian modes of inheritance explains how genes are passed on from ____ to _____ generation to generation
what does mendelian modes of inheritance refer to how genes are passed on from generation to generation
mendelian modes of inheritance includes: autosomal dominant, autosomal recessive, x-linked inheritance
parkinson disease is an example of what autosomal dominant
what is parkinson disease caused by a mutation, or change, in the alpha synclein gene
SNCA alpha-synclein gene
what is the 2 most common neurological disorder next to Alzeimer disease parkinsons disease
parkinson disease is the 2nd most common _____ ____ neurological disorder
parkinson disease affects __% of the population over 50 ~1%
parkinsons causes: resting tremors, muscular rigidity, slow movement, and possible dementia
what does congenital mean present at birth
out of autosomal dominant and autosomal recessive, which one is congenital autosomal recessive
autosomal recessive congenital hearing loss can come from parents that what? both have normal hearing
Autosomal recessive hearing loss: each parents carries a changed (____) copy of a gene that involves _____ mutated; hearing
autosomal recessive hearing loss: each parent has a ____% chance of passing on either the ____ copy of _____ copy 50; changed; unchanged
autosomal recessive hearing loss: children who receive both _____ copies have hearing loss changed
explain a female's sex chromosome they have to X sex xhromosomes (one X comes from mom and the other one from dad)
explain a male's sex chromosome have one X and one Y
where does the X-linked chromosome come from? where does the Y? X-always the mom; the Y-must always come from the dad
XX femal sex chromosome
XY male sex chromosome
what causes X-linked disorders mutations in the X chromosomes
what do mutations in the X chromosomes cause X-linked disorders
X-linked disorders are usually more seen in ___ males
what is usually seen more in males than in females X-linked disorders
explain why females do not suffer as much from X-linked disorders because with a mutation on one X chromosome, they still ahve another working chromosome that can perform the needed cell functions
explain why males more commonly suffer from X-linked disorders because with a mutation on their only X chromosome, they are often more severly affected by a mutation in an X X-linked gene
what is the most common inherited cause of mental retardation fragile X syndrome
fragile X syndrome is the most common cause of ____ ____ mental retardation
what is the ratio of males with mental retardation 1:3,600
what is the ratio of females with mental disorders 1:4000-6000
fragile X syndrome can cause: moderate to severe mental retardation, autistic or autistic like behaviors, and characteristic facial features
mild mental retardation in 50% of ____ with the ____ girls; mutation
major causes of illness and death worldwide are ______ multifactorial
non-mendelian inheritance = _____ inheritance multifactorial
True/False of non-mendelian inheritance: No single gene is the cause of the disorder True
Non mendelian inheritance: if a single gene is not the cause of the disorder, what is? several genes interacting with eachother and with the environment to produce a disorder, birth defect, or syndrome
According to studies, what factors could cause cleft lip/palate a number of genes as well as environmental genes including the following: drugs, infections, maternal illnesses, maternal smoking and alcohol use, and folic acid deficiency
anti anti-seizure drugs is an example of what? a drug that could assist in the cause of a cleft lip/palate
how can you typically tell if there is a strong genetic contribution? if it runs in the family, if multiple family members are affected, if there are multiple birth defects or health problems, or if there are developmental delays
What does it mean if something "runs in the family" if something affects more than one generation of a family
developmental delays refers to what mental retardation
what are some questions you ask the family? 1-is there a history of developmental delays in the family, 2-learning disabilities, 3-people were slow or in special ed, 4-classes or did not finish school, 5-has any1 in the family had a history of hearing or vision problems
what about the head do you examine? size, shape, symmetry, age (gestational or phonological)
size of the head may indicate what? the size of the brain
small head= microcephaly
large head= macrocephaly
what is hydrocephaly enlarged skull
abnormal accumalation of CSF= enlarged skull
when there are genetic abnormalties that affect the brain, it is likely that ____ will also have abnormalties face
what face structures do you typically examine? forehead, mandible, orbits, nasal bones, facial cleft
the term used for small eyes microphthalmia
the term used for abnormally large eyes exorbitism
an example of exorbitism crouzon syndrome
what can be both a diagnostics and indicative of possible cognative problems caused by brain abnormalities the size of the eyes
other then eye size, what other eye characteristics do you examine position of the eyes, symmetry, orientation and functioning of the eyes
what about the ears do you examine size, structure, position and orientation
abnormal size, too few or too many teeth, eruption all fall under the catagory of what dental condition
what about their dental condition do you examine abnormal size, too few or too many teeth, eruptions
what contains the 23 sets of chromosomes DNA
compare/relate structural genes and regulatory genes structural genes are the kinds of tissue or metabolic functions & regulatory genes are how genes are expressed
making sure we have all the proper bones is an example of _____ ____ structural genes
2 eyes & eye color is an example of what kind of gene structural
gene 23 down syndrome
webbed hands and feet is an example of what? a direct effect/influence if a gene
facial defects is an example of ___ ____ direct effect
what is the difference between a direct effect and an indirect influence of a gene direct: when a particular gene causes a disorder or anomoly in an embryo; indirect: a problem or abnormalty resulting secondarily from a genetic disorder
cascading from Pierre Robin, one would have what certain features? a protruding tongue, malformed teeth, and always open mouth
what appears together that represents a clinical picture or inherited anomaly syndromes
sign is ____ characteristics evident in particular syndromes physical
reoccuring ear infections can be an example of what a symptom of down syndrome
a sign of down syndrome the facial characteristics
signs and symptoms appear ____ or in a ____ together; sequence
what was the purpose of the human genome project to ID each chromosome and tell what growth and developmental syndromes were associated with each
what did the human genome project do to each chromosome ID each
why did the human genome project ID each chromosome to tell what growth and developmental syndromes were associated with each of those chromosomes
cerebral spinal fluid causes a ____ head size large head size
how does cerebral spinal fluid influence head size? it causes pressure within the skull and the brain swells
what can head size be refered to genetic counseling/testing since we dont diagnose medical conditions
when do we observe the face when there are genetic abnormalties that affect the brain
turner syndrome has some of these abnormalities nasal bones (missing or malformed)
orbits refer to eye sockets
what do you examine about the mandible? facial cleft? position or retraced; lack of fusion with skull bones
what is associated with bones of hard palate cleft lip
the size of the eyes is both ____ and ____ of possible developmental and cogntivie problems caused by brain abnormalities diagnostic; indicative
what is eruption? knowing how many teeth a child should have at certain ages
ASHA promotes EBP as what? a vital part of providing the best service possible to clients and caregivers
EBP evidence based practice
what factors may affect the use of EBP workplace factors, SLP's knowledge about EBP, and perceptions about rewards/consequences of using EBP as vital parts of their jobs
the trilateral model of EBP relates what 3 factors current best evidence, clinical expertise, and client value
EBP is an approach in wich current, high quality research ____ is integrated with practitioner ___ & client preferences and ___ into the process of making clinical decisions evidence, expertise, values
define evidence based practice an approach in with current, high quality research evidence is integrated with practitioner expertise and client preferences and values into the process of making clinical decisions
EBP is centered around who? the client and their family
clinically relevent research best research evidence
what does best research evidence examine? the precision and accuracy of diagnostic tests and the efficacy of treatment and its application to everyday practices
the evidence is to be considered in the context of what? the clinician's own expertise and the client's expressed wishes and values
ASHA has a ____ ____ on EBP advisory committee
ASHA: establish a set of ____ and __ related to EBP for consistent use throughout ASHA terminology; definitions
ASHA: _____ & _____ clinical questions identify; prioritize
ASHA convenes panels of independant knowledgeable reviewers to what? conduct evidence review on clinical questions
what does ASHA establish processes for the conduct and dissemination of evidence reviews
what does ASHA advise the national office staff on members' needs in the area of EBP
what is intrinsically futuristic research
research is _____ futuristic intrinsically
how is research intrinsically futuristic? it is always directed to the next experiment, theoretical advance
explain how research is challanging to our profession because communication sciences and disorders constitutes a field of broad and expanding horizons
Piklke and Byerly, 1998 "science policy implements a social contract"
what are subject to the major forces of social policy all areas of research
all areas of research are subject to what? social policy
how will the future of science be defined by the social contract through which society provides the resources for science, and in turn, reaps the benefits of scientific achievements
the future of ____ will be defined by the social contract through which society provides the _____ for science, and in turn reaps the benefit of scientific ______ science; resources; achievements
whose obligation is it to inform the public and policy makers about what kind s of scientific advances are likely and at what costs scientists
what are scientists obligated to inform the public and policy makers about what kinds of scientific advances are likely and at what cost
what is the purpose of research 1-discovery 2-accurate/effective dissemination of new knowledge
research gives new knowledge for who other researchers, clinical practitioners, and to the public
what does research in clinical fields control the general problem of demonstrating desired outcome at an affordable cost
an observed consequences is known as what? an outcome
what is an outcome? an observed consequence, usually an observation made at one point in time compared to an observation made later
an outcome does not index ______ or _____ efficacy or effectiveness
what are two types of outcomes clinical and functional
define clinical outcome is the effect of a treatment or intervention
clinical outcome is the effect of a ____ or ____ treatment; intervention
define functional outcome effects that pertain to the basic demensions of life
activities of daily living is an example of what type of outcome functional
efficacy is the comparison of what 2 or more treatments
define efficacy the comparison of 2 or more treatments when performed by competent specialists under ideal conditions
what tells us which of 2 procedures is better or more successful eficacy
eficacy tells us which of 2 procedures is ____ or more _____ better; successful
define effectiveness the outcome of intervention when it is conducted under conditions available in the community
effectiveness is the relationship between what? the benefit of an intervention and the cost of its deliveray
efficacy is the probability of benefit to ____ in a ______population from a procedure applied for a given disorder in _____ conditions individuals; defined; ideal
effectiveness is the probablilty of benefit of a ____procedure in the _____ population of individuals with a given disorder under ____ conditions given; general; average
how is effectiveness and efficacy ideally related effectiveness studies would be conducted after efficacy has already been demonstrated
ideally, effectiveness studies would be conducted after what? after efficacy has already been demonstrated
what can not be determined based on single-subject studies efficacy
efficacy cannot be determined based on what? single-subject studies
functional benefits can be measured for activies that are part of what 3 factors? daily living, educational achievement, occupational performance or placement
daily living, educational achievement, and performance/placement are activities that can measure ____ _____ functional benefits
True/False: it is not sufficient to demonstrate that a client or patient improves to some degree on a test developed for a specific kind of purpose True
it is not suffiecient to demonstrate that a client or patient improves to some degree based on what a test developed for a specific kind of performance
evidence based practice is the logical result of demands for what scientific documentation of clinical practice
evidence based practice is vital for what? providing optimal clinical services
what is vital for providing optimal clinical services evidence based practice
explain best evidence applying criteria to determine the credibility of a research study or a group of studies under review
best evidence is applying ___ ____ to determine the ___ of a research study or group of studies under review specific criteria; credibility
what is important to be guided by the least biased sources our diagnostic and treatment decisions
it is important that our diagnostic and treatment decisions are guided by what? the least biased sources
what are key features of evidence based practice systematic reviews and rankings of the evidence
what are typically graded in some manner ranking systems for the strength of the recommendations
how are the ranking systems for the strength of the recommendations graded? Grade A: 1 or more randomized control trials Grade D: recommendations are supported by expert opinion without explicit appraisal
Grade A is one ore more _____ _____ trials randomized controlled
Grade D is recommendations are supported by expert _____ without explicit appraisal opinion
the _____ the ranking, the more ______ the evidence higher; credible
what effect does higher ranking have on evidence? it makes it more credible
True/False: less credible sources are bogus False
what could it mean if a source has less credibility that the evidence available has not yet been tested on the level of scrutiny of higher ranking evidence
what is the purpose of systematic review to look for converging evidence from multiple, credible studies
what do systematic reviews sometimes reveal conflicting findings in the literature
systematic reviews can refer to close _____ of the controls imposed and ____ of study examination; design
define meta-analysis a statistical method for combining data from two or more published studies
meta-analysis is a statistical method for combining what? data from 2 or more published studies
how does meta-analysis usually intend to examine the effect of a given procedure or treatment area? by applying statistical methods to combine the results from a group of studies examing the same or similar questions/hypotheses
what kind of experiment involves selecting groups without any random preselection groups/control group quasi-experiment
explain what quasi-experiment involves selecting groups, upon which a variable is tested, without any random preselection processes and there is no control group
consensus conference is a group judgement process for what? the synthesis and evaluation of scientific data
what brings together a group of acknowledged experts who typically have dissimilar opinions on some or all aspects of a problem consensus conference
True/False: consensus conference brings together knowledgable experts how have similar opinions on a problem False
list the 5 levels of evidence for studies of efficacy 1a, 1b, lia, lib, III, IV
explain 1a well-designed meta analysis of > 1RCT
what is the difference between 1b and lia? 1b is well-designed randomised control study and lia is well-designed controlled study without randomization
what is the main factor the differentiates 1b and lia randomization
what is the difference between lib and III lib: well designed quasi-experiment study & III is well designed nonexperimental studies
correlational and case studies refers to what level of evidence III
what is the description of IV expert committee report, consensus conference, clinical experience or respected authorities
"Do the right ___ things for the right ____ reasons" clinical; theoretical
what does the practice of evidence-based medicine mean? integrating individual clinical expertise with the best available external clinical evidence from systematic research
the practice of evidence based medicine means integrating what 2 factors individual clinical expertise and best available external clinical evidence from systematic research
what enables clinicians to determine which of the available clinical methods are likely to be most effective in a specific situation the use of EBP
what does the use of evidence based practice enable clinicians to determine which of the available clinical methods are likely to be most effective in a specific situation
what should EBP be a template for professional practice
what is another term related to EBP data based decision making
data based ___ ___ is another term related to EBP decision making
list 3 other terminologies for EBP reliance on hard data, analytical process, focus on what works
list the steps in the process of EBP step 1: framing the clinical question, step 2: finding the evidence, step 3: assessing the evidence, step 4: making the decision
Step 1: what is the most widely used approach? PICO-population, intervention, comparison, outcome
explain what step:2 means by finding the evidence seek out scientific evidence to help inform the treatment decision
what types of evidence is used in step:2? systematic reviews, individual studies
what are 2 important factors in assessing the individual relevance of the review to your specific clinical question, consider who wrote or published the review
explain study quality the extent to which a study was designed and implemented appropriately
study quality is done under which step? step 3: assessing the evidence
what do you typically combine to make a specific clinical decision with a specific patient clinical expertise, the patient's perspective, and the available scientific evidence
if there are guidelines available, you must make sure that they are ___ and ____ to your client relevent and appropriate
define language a system of codes and symbols used in communication; a form of social behavior shaped and maintained by a verbal community
define culture the totality of socially transmitted behaior patterns, arts, beliefs, institutions, and all other products of human work and thought
culture is the predominating ____ & ____ that characterize the functioning of a group or organization attitutes and behavior
what is a biological subspecies, or a variety of a species race
what does a race consist of a more or less distinct population with anatomical traits that distinguish it clearly from other races
what does ethnicity refer to a selected cultural and sometimes physical characteristics used to classify people into groups or catagories considered to be significantly different from others
what is language an important aspect of the total cultural practices of a society
why is language sometimes refered to as a vehicle? because it transmits cultural practices from one generation to the next
what part of language varies within cultures and between cultures? language context and use
what is important for SLP and Audiologists to understand the various social uses of language and their influences on communication
how do children initially acquire their language? within their family context
later, children elaborate their aqcuired language in broader ____ & ___ contexts social and educational
sequently list how children aquire their language first, within their family context; later, in broader social and educational context
what do the broader social and educational contexts help expand the cultural influences on communication
True/false: family context help expand the cultural influences on communication false
some societies are more ____ in cultural practices than others homogenous
true/false: most countries of the world are multicultural true
explain how most countries of the world are multicultural there is a mixture of varied cultural practices, different religions, races, & ethnicities contribute to this diversity
what factors contribute to countries diversity different religions, races, and ethnicities
what has been increasing rapidly in the U.S. the diversity
multiculturalism and ____ go together multilingual
are most countries multilingual? yes
what does unilingual mean the use of a single language
what term is given to one who speaks 2 languages bilingual
what is another name for multilingual polygot
what does multilingual mean? when one speaks more than two languages
multicultural is a country or society or different ____ _____ cultural practices
what does multicultural mean a country or society of different cultural practices
true/false: language is spoken the same way by all members of that particular language community false
language use varies across ____ and ____ locations people; geographic
what is a dialect? variations of a specific language
a dialect refers to ____ of a specific language variations
what term is used for people who speak languages other than english linguistic minority
linguistic minority: people who speak languages other than what? english
has there been a steady number, increasing, or decreasing number to the people belonging to linguistic minority groups steady increase
true/false: people living in different geographic regions tend to speak different dialects of the same language true
people speaking the same language can speak with different _____ in different _____ dialects; geographic regions
what does each dialect have a characteristic sound pattern including accents and typical expressions
societies that have marked socioeconomic classes show significant ____ ___ accross those classes dialectal variations
give an example of influence that socioeconomical levels have on dialect Britain compared to U.S.
what are socioeconomic classes also related to economic, geographic, and educational level of speakers
define registers variation in language use that depend on the speaking situations
motherese is an example of ____ register
motherese is speech directed to who? young children by there mothers
explain how the speaking situation influences a dialect factors such as: the listener, topic, the relation between the speaker and listener along with other factors vary and can alter the form of language
teenletcs is an example of ____ peer-group
genderlect compares what? males vs. females
what are some subgroup memberships that can influence dialects elderly, peer-group, genderlect
list the following aspects that can influence a dialect geographic regions, socioeconomic levels, speaking situations, subgroup membership
what do SLPs have to sort out individuals who do not speak english from those who have a disorder of communication in the native language, english, or both
true/false: SLPs are not required to always consider dialects, just in certain cases false
what kind of unique characteristics may each dialect have phonological, semantic, morphological, syntactic, and pragmatic
english is spoken around the world as a ___ dialect and a ____ dialect primary; secondary
true/false: the way english is spoken around the world also varies true
what is the different between a primary and a secondary dialect primary-only speak one language; secondary-dialects of english that are learned and used as a second language
what is the largest group of secondary dialect spanish=hispanics
what is AAE a native english dialect but may have been influenced by african descendants
AAE is a product of ____, ____ and ____ forces historical, social, cultural
true/false: AAE is just just used among african americans false
who uses AAE/aspects of AAE african americans and people of other races
AAE variations are not haphazard mistakes, but are instead considered what? systematic and patterned behaviors
the 2nd most common language spoken in U.s. spanish
3 major dialects that are spoken most often in u.s. mexican, cuban, puerto rican,
spanish-influence english is the term given to children who speak what? spanish as their primary language at home and learn to speak emglish as 2nd language
many asian countries are ____ multilingual
what system of most asian languages varies from the english language the phonetic system
the native language influences what about the second lanuage? the acquisition and production
which patterns will the 2nd language have of the native languange the sound and linguistic stress
define code switching when bilingual speakers, while in the company of similar bilingual speakers, switch back and fourth from their 1st to 2nd language
give examples of mixed languages spanglish, texmex
what does simultaneous bilingualism mean when a child can zcquire 2 languages at the same time
how does sequential bilingualism differ from simultaneous bilingualism when a childe acquires two languages one after the other
what effect does the child have if both parents talk exclusively in their own language the child learns the 2 languages somewhat faster
the child will mix languages when the parents ___ or ____ languages switch or mix
up to age ___, bilingual children will have only 1 word of either language for each object or event 2 yrs old
another name for sequential bilingualism successive
successive bilingualism refers to what a child that has been monolingual for some time and begins to learn a 2nd language after their 3rd bday
under what age can children successfully and rapidly learn a 2nd language in their natural environment under age 7
True/false: variations of language are deviations false
describe asha's position of dialects dialectal variations are not disorders of communication
if individuals are limited in both languages, how should they be assessed assessed in both languages
who describes 8 distinctive parameters of a culture richard brislin
list the 8 parameters that characterize a culture the collectivist-individualist deminsion, views of time and space, language and communication style, roles, importance of work, class and status, rituals and superstitions, beliefs and values
cultural competence= our knowledge, skills, and attitudes
what is best considered a developments process cultural competence
knowledge refers to what the information or content that we need to know in order to become culturally competent
Skills refer to what what we should be able to do with our knowledge and how we should apply it in our practice of the professions
attitudes refer to what focusing on the kind of profession we wish to be and the values we wish to embrace as we strive for cultural competence
what is the frame work of the stages of cultural competence three overlapping stages of: awareness, application, advocacy
why is awareness important clinicians must first be able to understand their own beliefs, values, and stereotypes in order to better understand culture and its multiple parameters
the application stage emphasizes translating knoweldge about cultural and linguistic diveristy into what approproate skills and practices that impact service delivery to diverse clients
explain the advocacy stage using the knowledge and skill to collectivley champoin culturally competent practice of the profession
which stage actively promotes diversity advocacy stage
summarize cultural competence a life long committment to being teachable, remain flexible in assessing clients, present recommendations to achieve successful outcomes
Created by: deborahpuckett
 

 



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