Assessing communicative participation in preschool children with the Focus on the Outcomes of Communication Under Six: a scoping review

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 on communicative participation; how FOCUS captures change relative to measures of impairment; and how FOCUS performs when used at different intervals. Adaptations included use of the FOCUS as a descriptive or discriminative tool; use with children outside the validated age range; using select items; and use with typically developing children. Interpretation: FOCUS is used worldwide in research and practice, and much has been learned about children’s communicative participation. Future research is needed to explore the relationship between children’s impairments and their communicative participation, develop a FOCUS App, and develop and validate of a school-age FOCUS

Intervention goals for preschoolers with language difficulties and disorders A scoping review using the ICF framework

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 5), intervention area (language), and study design (all but systematic reviews and clinical practice guidelines) specified as inclusion criteria. Language goals were extracted and categorized into the ICF components. From there, the distributions of these ICF components were compared between intervention studies for different language difficulty/disorder subtype. Results: A total of 287 articles were identified; 140 met inclusion criteria. Of the 293 goals extracted, 48% aligned with the Activities component of the ICF framework, followed by Participation (26%), Environmental Factors (20%), Body Functions and Structures (3%) and Personal Factors (3%). Most participation-focused goals were reported from intervention studies of preschoolers with a language difficulty/disorder associated with a biomedical condition. Conclusions: Few participation-focused goals were reported in intervention studies for preschoolers with language difficulty/disorder without an associated condition. Future work is needed to support integrating the ICF framework in goal setting for both research and practice

Interrater Reliability of the FOCUS-34: Parent-to-Parent and Parent-to-Clinician

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

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

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 pandemic during videoconference interviews. A narrative inquiry approach was used to analyze interview transcripts to identify the processes (or steps) this program took to implement telepractice and to understand the facilitators and barriers to telepractice implementation during the pandemic. Results: The following six stages were identified from clinicians\u27 narratives: abrupt lockdown; weeks of uncertainty; telepractice emerged as an option; preparation for telepractice; telepractice trials; and finally, full implementation of telepractice. The stages of events offered significant insights into how government public health measures influenced clinicians\u27 decisions and their processes of adopting telepractice. In terms of barriers, clinicians reported a lack of knowledge, skills and experience with telepractice and a lack of technological support. The organization\u27s learning climate and team approach to transitioning services were identified as the main facilitator of implementation. Conclusions: Findings suggest a need for better coordination of public health measures and professional services, which would have eased clinicians\u27 stress and facilitated an earlier transition to telepractice. Fostering an organization\u27s learning climate may improve organization\u27s resilience in response to emergency situations

Strengths and challenges of the COSMIN tools in the appraisal of outcome measures: A case example for speech-language therapy

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 is used in various contexts around the world. Results: Using COSMIN guidelines, the FOCUS was categorized as a “Category A” tool because there was a sufficient level of evidence to support its content validity and internal consistency. According to the COSMIN guidelines, this means that the FOCUS can be recommended for clinical use. The quality of evidence supporting measurement properties of the FOCUS received a rating of ‘moderate’, meaning users can have moderate confidence in its measurement properties. Since these ratings from the COSMIN tools may be unclear to users of the FOCUS, we have provided more specific recommendations. Conclusions & Implications: The COSMIN tools offer detailed standards to support the appraisal of outcome measures available to SLTs. However, several limitations were observed, and recommendations to support the application of the COSMIN tools are provided

Promoting consistent use of the communication function classification system (CFCS)

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 intervention. Fifty-two participants completed an electronic pre-test survey, reviewed intervention materials online, and then immediately completed an electronic post-test survey. Results: The intervention improved clinicians’ understanding of how the CFCS should be used, their intentions to use the tool in the standardized way, and their abilities to make correct classifications using the tool. Conclusions: Findings from this work will be shared with representatives of the Ontario PSLP. The intervention may be disseminated to all speech-language pathologists working in the program. This study can be used as a model for developing and disseminating KT interventions for clinicians in paediatric rehabilitatio

Usability and Feasibility of a Spoken Language Outcome Monitoring Procedure in a Canadian Early Hearing Detection & Intervention Program: Results of a 1-Year Pilot

Abstract 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;0 and individual vulnerability monitoring of key domains of spoken language known to be at risk in children who are deaf/hard-of-hearing. Methodology: Speech-language pathologists (SLPs) in the IHP piloted the new procedures for one year and provided feedback on the procedure through surveys at the end of the pilot. Results: Data was suggestive that the Program-level procedure might be sensitive to change over time and known predictors of spoken language outcomes. Some, but not all, Program-level test scores were predicted by the presence of additional developmental factors. None of the test scores were significantly predicted by severity of hearing loss. Depending on the tests and scores used, some aspects of the Program-level procedure to change over time. There was insufficient evidence to support individual vulnerability monitoring. SLPs reported significant concerns about the time involved in implementing both procedures. Conclusions: This article describes preliminary evidence suggesting that the Program-level procedure might be feasible to implement and useful for evaluating EHDI programs. Future evaluations are needed to determine whether the procedure can be accurately implemented to scale in the IHP, and whether the data that results from the procedure can meaningfully inform stakeholders’ decision-making

Current practices, supports, and challenges in speech-language pathology service provision for autistic preschoolers

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 identify barriers and supports (facilitators) to providing services in the community using the Consolidated Framework for Implementation Research (CFIR) as a framework. Methods: A cross-sectional online survey was used to collect qualitative and quantitative data from clinicians in Ontario Canada who were providing speech and language services to preschool children with suspected or diagnosed autism. Quantitative data were used to describe clinicians” practices, and qualitative data captured their perspectives on barriers and supports to providing services. Results: A total of 258 clinicians participated in the survey. On average, clinicians reported almost half of the preschoolers on their caseload had either diagnosed or suspected autism. There was consistency across the skill development areas assessed by SLPs, and targeted during therapy sessions, with the top four areas targeted being: foundational social communication, language, play and pragmatics. However, there was wide variation in speech and language assessment and intervention practices reported by this sample of clinicians (i.e., service delivery models, tools or programs used, length and duration of therapy services, level of collaboration with other professionals). Clinicians identified several barriers to providing services: limited funding and time, lack of inter-professional collaboration, difficulty accessing services, community messaging about autism services, family readiness and clinician knowledge. Supports (facilitators) include access to autism-focused professional development, inter- and intra-professional collaboration, and access to additional supports in the communit

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

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 56 speech-language pathologists (56/73 who were invited, 77% response rate) who took a pre-module survey, completed the online learning module, and then immediately took a post-module survey. After completing the learning module, speech-language pathologists reported improved perceptions about outcome monitoring, good understanding of the procedures to be implemented, and intentions to implement the new procedures into practice. Implementation materials were rated as highly valuable. Online learning modules can be used to effectively translate evidence-based assessment procedures to speech-language pathologists. Developing interventions using theory and in collaboration with stakeholders can support the implementation of these types of procedures into practice

A population-based study of communicative participation in preschool children with speech-language impairments

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 each CFCS level. Models allowed for variation in initial FOCUS scores at 18 months, rate of growth with age, and rate of acceleration/deceleration with age. Results. Starting FOCUS score (18 months) varied inversely with CFCS level at entry to the program. Growth was initially rapid and then levelled off for children in levels I-III. Growth was less rapid for children in level IV, but levelled off, and was slow but continual for children in level V. Interpretation. This work can help us to move beyond traditional impairment-based thinking and shows that children can make meaningful communicative changes regardless of their function