Medicine and Health Sciences Commons^™

Working Towards Recommended Terminology In The Canadian Preschool Speech-Language Pathology Context, Alison Csercsics, Lisa Md Archibald, Barbara Jane Cunningham

PRECISe Preschool Speech and Language Publications

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Purpose: This quality improvement project aimed to address the inconsistent use of clinical labels across a preschool speech and language program in Ontario, Canada. The study investigated whether a multi-component knowledge translation intervention could increase speech-language pathologists’ (SLPs’) knowledge about the recommended clinical labels, motivate their intentions to use the labels, and facilitate practice change during a three-month pilot period.

Method: The Diffusion of Innovations Theory was utilized to identify and address known and suspected barriers and facilitators that could influence the adoption of consistent terminology. The intervention was evaluated using a pre-experimental study design (with pre-post-follow-up testing) and included …

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Families' Experiences In The Virtual Hanen More Than Words Program During The Covid-19 Pandemic, Lauren Denusik, Michelle Servais, Danielle Glista, Kathryn Hatherly, Sheila Moodie, Janis Oram Cardy, Elaine Weitzman, Bj Cunningham

PRECISe Preschool Speech and Language Publications

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Abstract

Purpose: The COVID-19 pandemic required most pediatric rehabilitation programs to shift to a virtual delivery format without the benefits of evidence to support this transition. Our study explored families' experiences participating virtually in More Than Words, a program for parents of autistic children, with the goal of generating new evidence to inform both virtual service delivery and program development.

Method: Twenty-one families who recently completed a virtual More Than Words program participated in a semistructured interview. The interviews were transcribed and analyzed in NVivo using a top-down deductive approach that referenced a modified Dynamic Knowledge Transfer Capacity model. …

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Interrater Reliability Of The Focus-34: Parent-To-Parent And Parent-To-Clinician, Barbara Jane Cunningham, Peter Rosenbaum, Anastasia Nepotiuk, Nancy Thomas-Stonell

PRECISe Preschool Speech and Language Publications

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This brief report presents interrater reliability data for the Focus on the Outcomes of Communication Under Six (FOCUS-34) between parents, and between parents and speech-language pathologists (SLPs). Reliability for all three raters combined was good to excellent across three assessments. Reliability for pairs of raters was variable but generally good.

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Engaging Clinical End Users In The Development Of An Outcome Measurement Protocol For Pediatric Communicative Health Systems, Victoria Sherman, Danielle Glista, Barbara Jane Cunningham

PRECISe Preschool Speech and Language Publications

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Purpose: To develop a conceptual framework of the factors likely to influence clinicians' use of a new participation-focused outcome measurement protocol in a large paediatric speech-language pathology program.Method: A convenience sample of 27 end users (clinicians, managers) were recruited from Ontario, Canada's Preschool Speech and Language Program. Participants engaged in one virtual concept mapping session in groups of five to six during which they learned about the new protocol, and generated statements in response to a prompt asking them to identify factors that would influence their use of the protocol. Following all sessions, participants asynchronously sorted and …

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Speech-Language Pathologists’ Treatment Goals For Preschool Language Disorders: An Icf Analysis, Elaine Yl Kwok, Peter Rosenbaum, Barbara Jane Cunningham

PRECISe Preschool Speech and Language Publications

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Purpose: The World Health Organization's International Classification of Functioning, Disability and Health (ICF) provides a comprehensive framework to conceptualise clinical services. This study explored how speech-language pathologists (SLPs) conceptualised therapy goals for preschoolers with language difficulties and disorders within the ICF framework.Method: An online survey was distributed to SLPs practising in a publicly funded Preschool Speech and Language program in Ontario, Canada. SLPs rated their familiarity with the ICF framework, and then reported all therapy goals for one child with language difficulty/disorder on their caseload. For each reported goal, SLPs indicated the ICF component(s) they felt the …

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Intervention Goals For Preschoolers With Language Difficulties And Disorders A Scoping Review Using The Icf Framework, Elaine Kwok, Carly A. Cermak, Kathryn Hatherly, Barbara Jane Cunningham

PRECISe Preschool Speech and Language Publications

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Purpose: The primary aim of this scoping review was to categorize language therapy goals reported in intervention studies for preschoolers (i.e., children from 0 to 5;0 years old) with language difficulties and disorders within the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) framework. A secondary aim was to determine whether different therapy goals were reported for different language difficulty/disorder subtypes (i.e., comparing language difficulty/disorder associated with a biomedical condition to those without an associated biomedical condition).

Method: The scoping review followed Arksey and O’Malley’s (2005) guidelines. Articles were retrieved from speechBITE, with age (under …

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Usability And Feasibility Of A Spoken Language Outcome Monitoring Procedure In A Canadian Early Hearing Detection & Intervention Program: Results Of A 1-Year Pilot, Olivia Daub University Of Western Ontario, Bj Cunningham, Marlene P. Bagatto, Janis Oram Cardy

PRECISe Preschool Speech and Language Publications

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Purpose: Best practice recommendations for Early Hearing Detection and Intervention (EHDI) programs include routine spoken language outcome monitoring. The present article reports on pilot data that evaluated the usability and feasibility of a spoken language outcome monitoring procedure developed for Ontario’s Infant Hearing Program (IHP). This procedure included both Program-level monitoring using omnibus language tests from birth to 6 years of age and individual vulnerability monitoring of key domains of spoken language known to be at risk in children who are deaf or hard of hearing.

Methodology: Speech-language pathologists (SLPs) in the IHP piloted the new procedures for one year …

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The Process Of Telepractice Implementation During The Covid-19 Pandemic: A Narrative Inquiry Of Preschool Speech-Language Pathologists And Assistants From One Center In Canada, Elaine Yl Kwok, Jessica Chiu, Peter Rosenbaum, Barbara Jane Cunningham

PRECISe Preschool Speech and Language Publications

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Background: Many professional services were pressed to adopt telepractice in response to the global coronavirus SARS-CoV-2 (COVID-19) pandemic. The need to adopt a new service delivery approach quickly created different implementation challenges. This study explored the lived experiences of frontline clinicians who successfully transitioned their in-person speech-language therapy services to telepractice through an implementation science lens.

Methods: The study was conducted in partnership with one publicly funded program in Ontario, Canada that offers services to preschoolers with speech, language and communication disorders. Sixteen frontline speech-language pathologists and assistants at this organization shared their lived experience transitioning to telepractice during the …

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What Do Speech-Language Pathologists Want To Know When Assessing Vocal Development In Children Who Are Deaf/Hard-Of-Hearing?, Olivia Daub, Marlene P. Bagatto, Janis Oram Cardy

PRECISe Preschool Speech and Language Publications

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Abstract

Purpose: Delays in vocal development are an early predictor of ongoing language difficulty for children who are deaf/hard-of-hearing (CDHH). Despite the importance of monitoring early vocal development in clinical practice, there are few suitable tools. This study aimed to identify the clinical decisions that speech-language pathologists (SLPs) most want to make when assessing vocal development and their current barriers to doing so.

Method: 58 SLPs who provide services to CDHH younger than 22 months completed a survey. The first section measured potential barriers to vocal development assessment. The second section asked SLPs to rate the importance of 15 clinical …

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Current Practices, Supports, And Challenges In Speech-Language Pathology Service Provision For Autistic Preschoolers, Amanda V. Binns, Barbara Jane Cunningham, Allison Andres, Janis Oram Cardy

PRECISe Preschool Speech and Language Publications

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Background: Speech-language pathology services are among the most frequently accessed services for young autistic children. Therefore, understanding the nature of these services, what challenges these clinicians face, and what supports they value is critical for developing appropriate policies and practices that can maximize positive outcomes for children and families. This study had two primary aims. The first was to examine the self-reported assessment and intervention practices of community-based Speech Language Pathologists (SLPs) and communicative disorders assistants (CDAs; who provide services under the supervision of a SLP) in supporting preschool children with suspected and diagnosed autism. The second aim was to …

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Exploring Practice-Based Clinical–Research Partnerships In Speech-Language Pathology: A Scoping Review, Meghan Vollebregt, Lisa Archibald, Julie Theurer, Janis Oram Cardy

PRECISe Preschool Speech and Language Publications

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Collaborative partnerships between speech-language pathologists and researchers present an opportunity for practice-based research. For practice-based research to become more widely used in speech-language pathology, a crucial step is outlining the potential purposes and outcomes of these partnership projects. The current article is two-fold. First, we describe a model for practice-based partnerships between researchers and speech-language pathologists. The practice-based research cocreation model developed for this project includes three distinct partnership outcomes: (a) creating practice, (b) capturing current practice, and (c) changing practice. Then, informed by our model, we completed a scoping review to explore the extent and type of practice-based research …

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Looking Back And Moving Forward: A Scoping Review Of Research On Preschool Autism Interventions In The Field Of Speech-Language Pathology, Amanda Binns, Rachael Smyth, Allison Andres, Joyce Lam, Janis Oram Cardy

PRECISe Preschool Speech and Language Publications

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Background & Aims: Speech-language pathology services are frequently accessed by families of children who have suspected or diagnosed autism. This is expected given that social communication differences are a core feature of autism. This review looked broadly at the state of research in the field of speech-language pathology and preschool autism interventions in order to identify the types of studies that could be used to inform the practices of speech-language pathologists (SLPs), and to identify gaps in the field so they can be addressed in future research. Specifically, we examined the extent of research conducted on interventions delivered (at least …

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Reliability Of Speech-Language Pathologists’ Categorizations Of Preschoolers’ Communication Impairments In Practice, Bj Cunningham, Janis Oram Cardy

PRECISe Preschool Speech and Language Publications

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Abstract

Purpose An efficient and reliable way to categorize children's communication impairments based on routine clinical assessments is needed to inform research and clinical decisions. This preliminary study assessed interrater reliability of speech-language pathologists' categorization of preschoolers' speech, language, and communication impairments using a clinical consensus document.

Method

Six speech-language pathologists at three community sites worked in pairs to assess 38 children aged 1–5 years, then used the clinical consensus document to categorize children's communication impairments broadly. Identified language and speech sound impairments were further subcategorized.

Results

Speech-language pathologists had substantial to almost perfect agreement for three broadly focused impairment …

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Strengths And Challenges Of The Cosmin Tools In The Appraisal Of Outcome Measures: A Case Example For Speech-Language Therapy, Elaine Kwok, Peter Rosenbaum, Nancy Thomas-Stonell, Barbara Jane Cunningham

PRECISe Preschool Speech and Language Publications

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Background: The Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) is an international initiative that offers standardized and validated tools to guide the appraisal of outcome measures in healthcare.

Aims: This study aimed to explore the use of a new set of tools from COSMIN to appraise studies on outcome measures available to speech and language therapists (SLTs).

Methods: We used the COSMIN tools to appraise seven studies and a user manual that reported the measurement properties of the Focus on the Outcomes of Children Under Six (FOCUS), a validated measure of preschoolers’ communicative participation that …

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Exploring Speech And Language Intervention For Preschoolers Who Are Deaf And Hard Of Hearing: A Scoping Review, Janis Oram Cardy, Hillary Ganek

PRECISe Preschool Speech and Language Publications

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Purpose: The objective of this study was to summarize the extant literature on the effectiveness of speech and spoken language interventions for young children who are deaf or hard of hearing (DHH) to determine which types of speechlanguage interventions might be most effective, for which hearing levels and types of hearing losses, and at which dosage.

Methods: Using a scoping review methodology, a database search identified 10,360 studies of which 16 met the requirements for inclusion. Data was extracted from each for analysis.

Results: Due to the limited number of studies available, high variability in the nature of the studies, …

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Barriers And Facilitators To Implementation Of A Preschool Outcome Measure: An Interview Study With Speech-Language Pathologists, Elaine Yl Kwok, Sheila Tf Moodie, Bj Cunningham, Janis Oram Cardy

PRECISe Preschool Speech and Language Publications

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Barriers and Facilitators to Implementation of a Preschool Outcome Measure: An Interview Study with Speech-Language Pathologists

Abstract

Introduction: The Preschool Speech and Language Program in Ontario, Canada implemented the Focus on the Outcomes of Communication Under Six (FOCUS), an outcome measure, in 2012. This study aimed to investigate commonly experienced facilitators of and barriers to implementing the FOCUS in clinical practice from the perspectives of speech-language pathologists (SLPs). Methods: Thirty-seven SLPs participated in semi-structured interviews to share their experiences adopting the FOCUS in clinical practice. A deductive content analysis of interview transcripts was conducted using the Theoretical Domains …

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Developing A Spoken Language Outcome Monitoring Procedure For A Canadian Early Hearing Detection And Intervention Program: Process And Recommendations, Janis Oram Cardy, Olivia Daub University Of Western Ontario

PRECISe Preschool Speech and Language Publications

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Abstract

Purpose: Routine spoken language outcome monitoring is one component of Early Hearing Detection and Intervention (EHDI) programs for children who are hard of hearing and learning a spoken language. However, there is no peerreviewed research that documents how spoken language outcome monitoring may be achieved, or what processes EHDI programs can use to develop these procedures. The present article describes the process used by a Canadian EHDI program and the final recommendations that were developed from this process.

Methodology: Through consultation with the program’s stakeholders, consideration of the Joint Committee on Infant Hearing’s recommendations, and drawing on our own …

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Implementing Evidence-Based Assessment Practices For The Monitoring Of Spoken Language Outcomes In Children Who Are Deaf Or Hard Of Hearing In A Large Community Program, Barbara Jane Cunningham, Janis Oram Cardy, Olivia Daub University Of Western Ontario

PRECISe Preschool Speech and Language Publications

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The purpose of this quality improvement pilot was to evaluate the effectiveness of an online learning module for (a) changing speech-language pathologists’ perceptions about outcome monitoring and assessment protocols for children who are deaf or hard of hearing and (b) supporting speech-language pathologists’ understanding of evidence-based protocols to be implemented in their community-based program. Using principles of integrated knowledge translation and the Ottawa Model of Research Use, an online learning module was designed to support the implementation of evidence-based assessment protocols for these children in a large publicly funded program in Ontario, Canada. A pre–post study was then conducted with …

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Assessing Communicative Participation In Preschool Children With The Focus On The Outcomes Of Communication Under Six: A Scoping Review, Barbara Jane Cunningham, Nancy Thomas-Stonell, Peter Rosenbaum

PRECISe Preschool Speech and Language Publications

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Aim: To describe uses of the Focus on the Outcomes of Communication Under Six (FOCUS) in research since its publication in 2010. Method: Six databases were searched for the term ‘Focus on the Outcomes of Communication Under Six’. With additional searches we ascertained 70 articles, of which 25 met inclusion criteria for full review and data extraction. Results: The FOCUS has been used in research across multiple countries, purposes, populations, contexts, and versions. Evaluative studies have described the development of children’s communicative participation skills and factors that impact development of communicative participation; the impact of specific interventions …

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Lessons Learned In Practice-Based Research: Studying Preschool Language Interventions In The Real World, Rachael E. Smyth, Julie Theurer, Lisa Md Archibald, Janis Oram Cardy

PRECISe Preschool Speech and Language Publications

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Abstract

Background and aims: Practice-based research holds potential as a promising solution to closing the research-practice gap, because it addresses research questions based on problems that arise in clinical practice and tests whether systems and interventions are effective and sustainable in a clinical setting. One type of practice-based research involves capturing practice by collecting evidence within clinical settings to evaluate the effectiveness of current practices. Here, we describe our collaboration between researchers and clinicians that sought to answer clinician-driven questions about community-based language interventions for young children (Are our interventions effective? What predicts response to our interventions?) and to address …

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Using Implementation Science To Engage Stakeholders And Improve Outcome Measurement In A Preschool Speech-Language Service System, Barbara Jane Cunningham, Janis Oram Cardy

PRECISe Preschool Speech and Language Publications

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This tutorial presents one example of collaborative implementation research in a preschool speech-language service system - Ontario Canada’s Preschool Speech and Language Program. Working collaboratively with stakeholders including policy makers, managers, and speech-language pathologists (SLPs), four webinar modules were developed to support implementation of the Focus on the Outcomes of Communication Under Six (FOCUS), a new participation-focused outcome measurement tool in pediatric speech-language pathology. The webinar modules were pilot tested at two community sites to determine whether they were effective at increasing SLPs’ knowledge, perceptions, and intentions for practice. The Knowledge-to-Action framework was used to inform all phases of this …

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The Speech-Language Pathologist's Role In Supporting The Development Of Self-Regulation: A Review And Tutorial, Amanda Binns, Janis Oram Cardy

PRECISe Preschool Speech and Language Publications

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Purpose

Children’s engagement in self-regulation is a strong and positive predictor of their social and academic success, making self-regulation an important focus for caregivers and clinicians. The aims of this article are to provide a framework for understanding self-regulation and to identify strategies speech-language pathologists can use to integrate self-regulation work into their clinical practice.

Method

Empirically supported considerations describing the developmental progression from co-regulation to self-regulation are outlined, and the effects of stress on self-regulation are discussed. A clinical framework is provided to guide speech-language pathologists in considering stress and self-regulation in their clinical work. Strategies are provided to …

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Factors Contributing To Preschoolers' Communicative Participation Outcomes: Findings From A Population-Based Longitudinal Cohort Study In Ontario, Canada, Barbara Jane Cunningham, Steven E. Hanna, Peter Rosenbaum, Nancy Thomas-Stonell, Bruce Oddson

PRECISe Preschool Speech and Language Publications

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Purpose. To identify predictors of communicative participation outcomes for a large cohort of preschoolers with communication disorders.

Method. A secondary analysis of longitudinal program evaluation data from Ontario Canada’s Preschool Speech and Language Program (PSLP). Data available for 46,872 children 18-67 months of age (M = 41.76 mo, SD = 11.92, 68% male) were previously used to predict children’s communicative participation skill development in five levels of function. Demographic and intervention-based variables were added to the models to identify new predictors of growth.

Results. Three demographic and three intervention-based variables were statistically significant predictors of children’s communicative participation …

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A Population-Based Study Of Communicative Participation In Preschool Children With Speech-Language Impairments, Barbara Jane Cunningham, Steven E. Hanna, Bruce Oddson, Nancy Thomas-Stonell, Peter Rosenbaum

PRECISe Preschool Speech and Language Publications

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Aim. To develop statistical models of preschoolers’ communicative participation development and explore variations by level of function.

Methods. This was a secondary analysis of data from a longitudinal study of preschoolers with speech and language delays (N = 46,872, M age = 41.76, SD age = 11.92; 67% male) accessing publicly-funded services in Ontario Canada. Two measures were used: Focus on the Outcomes of Communication Under Six (FOCUS), measuring changes in communicative participation skills, and the Communication Function Classification System (CFCS), classifying communication function into one of five levels. We used mixed effects modeling to fit growth curves for …

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Validity Of The Communication Function Classification System For Use With Preschool Children With Communication Disorders, Mary Jo Cooley Hidecker, Barbara Jane Cunningham, Nancy Thomas-Stonell, Bruce Oddson, Peter Rosenbaum

PRECISe Preschool Speech and Language Publications

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Aim: To evaluate construct validity of the Communication Function Classification System (CFCS) for use with preschoolers with a range of speech and language disorders. Method: Seventy-seven preschoolers with speech and language disorders (M = 2.7 years, SD = 1.02 years) (50 males) participated in this cohort study. Preschoolers had speech and language, language-only, or speech-only disorders. Together with parent input, SLPs completed the CFCS at Time 1. Parents and SLPs then independently completed a validated change-detecting functional communication outcome measure, the Focus on Communication Outcomes Under Six (FOCUS©) three times – at assessment (Time 1), at the start of treatment …

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Current Methods Of Evaluating Speech-Language Outcomes For Preschoolers With Communication Disorders: A Scoping Review Using The Icf-Cy, Barbara Jane Cunningham, Karla N. Washington, Amanda Binns, Katelyn Rolfe, Bernadette Robertson, Peter Rosenbaum

PRECISe Preschool Speech and Language Publications

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Purpose: The purpose of this scoping review was to identify current measures used to evaluate speech-language outcomes for preschoolers with communication disorders within the framework of the International Classification of Functioning, Disability and Health – Children and Youth (ICF-CY) (World Health Organization, 2007). Method: The review included five phases outlined by Arksey and O’Malley (2005) and further developed by Levac et al. 2010: (a) articulating the research question, (b) identifying relevant studies, (c) study selection, (d) charting the data, and (e) collating, summarizing and reporting the results. The WHO ICF-CY was used to frame the measures included. Results: A total …

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Promoting Consistent Use Of The Communication Function Classification System (Cfcs), Barbara Jane Cunningham, Mary Jo Hidecker, Nancy Thomas-Stonell, Peter Rosenbaum

PRECISe Preschool Speech and Language Publications

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Purpose: We developed a Knowledge Translation (KT) intervention to standardize the way speech-language pathologists working in Ontario Canada’s Preschool Speech and Language Program (PSLP) used the Communication Function Classification System (CFCS). This tool was being used as part of a provincial program evaluation and standardizing its use was critical for establishing reliability and validity within the provincial dataset.

Method: Two theoretical foundations – Diffusion of Innovations and the Communication Persuasion Matrix – were used to develop and disseminate the intervention to standardize use of the CFCS among a cohort speech-language pathologists. A descriptive pre-test/post-test study was used to evaluate the …

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