Vocabulary intervention for adolescents with language disorder: a systematic review

Background: Language disorder and associated vocabulary difficulties can persist into adolescence, and can impact on long-term life outcomes. Previous reviews have shown that a variety of intervention techniques can successfully enhance students’ vocabulary skills; however, none has investigated vocabulary intervention specifically for adolescents with language disorder. Aims: To carry out a systematic review of the literature on vocabulary interventions for adolescents with language disorder. Methods & Procedures: A systematic search of 14 databases and other sources yielded 1320 studies, of which 13 met inclusion criteria. Inclusion criteria were: intervention effectiveness studies with a focus on enhancing oral receptive and/or expressive vocabulary skills in the study's aims; participants in the age range 11;0–16;11 with receptive and/or expressive language difficulties of any aetiology. Main Contribution: There was a high degree of diversity between studies. Types of intervention included: semantic intervention (four studies); comparison of phonological versus semantic intervention (two); and combined phonological–semantic intervention (seven). The strongest evidence for effectiveness was found with a combined phonological–semantic approach. The evidence suggested a potential for all models of delivery to be helpful (individual, small group and whole class). Conclusions & Implications: Tentative evidence is emerging for the effectiveness of a phonological–semantic approach in enhancing the vocabulary skills of adolescents who have language disorder. Future research needs to refine and develop the methodologies used in this diverse group of studies in order to replicate their findings and to build consensus

Task sharing in Zambia: HIV service scale-up compounds the human resource crisis

BACKGROUND: Considerable attention has been given by policy makers and researchers to the human resources for health crisis in Africa. However, little attention has been paid to quantifying health facility-level trends in health worker numbers, distribution and workload, despite growing demands on health workers due to the availability of new funds for HIV/AIDS control scale-up. This study analyses and reports trends in HIV and non-HIV ambulatory service workloads on clinical staff in urban and rural district level facilities. METHODS: Structured surveys of health facility managers, and health services covering 2005-07 were conducted in three districts of Zambia in 2008 (two urban and one rural), to fill this evidence gap. Intra-facility analyses were conducted, comparing trends in HIV and non-HIV service utilisation with staff trends. RESULTS: Clinical staff (doctors, nurses and nurse-midwives, and clinical officers) numbers and staff population densities fell slightly, with lower ratios of staff to population in the rural district. The ratios of antenatal care and family planning registrants to nurses/nurse-midwives were highest at baseline and increased further at the rural facilities over the three years, while daily outpatient department (OPD) workload in urban facilities fell below that in rural facilities. HIV workload, as measured by numbers of clients receiving antiretroviral treatment (ART) and prevention of mother to child transmission (PMTCT) per facility staff member, was highest in the capital city, but increased rapidly in all three districts. The analysis suggests evidence of task sharing, in that staff designated by managers as ART and PMTCT workers made up a higher proportion of frontline service providers by 2007. CONCLUSIONS: This analysis of workforce patterns across 30 facilities in three districts of Zambia illustrates that the remarkable achievements in scaling-up HIV/AIDS service delivery has been on the back of sustained non-HIV workload levels, increasing HIV workload and stagnant health worker numbers. The findings are based on an analysis of routine data that are available to district and national managers. Mixed methods research is needed, combining quantitative analyses of routine health information with follow-up qualitative interviews, to explore and explain workload changes, and to identify and measure where problems are most acute, so that decision makers can respond appropriately. This study provides quantitative evidence of a human resource crisis in health facilities in Zambia, which may be more acute in rural areas

Language Intervention Practices with School-Age Children with Spoken Language Disorders: A Systematic Review.

Purpose: This systematic review focuses on peer-reviewed articles published since 1985 that assess the outcomes of language intervention practices for school-age students with spoken language disorders. Method: We conducted computer searches of electronic databases and hand searches of other sources for studies that used experimental designs that were considered to be reliable and valid: randomized clinical trials, nonrandomized comparison studies, and multiple-baseline single-subject design studies. Results: The review yielded 21 studies concerning the efficacy or effectiveness of language intervention practices with school-age children since 1985. Eleven of the studies limited participants to children in kindergarten and first grade, and no studies were located that focused on students in middle grades or high school. The relatively high quality of the studies that met our criteria, and the moderate-to-high effect sizes we calculated for the majority of studies, suggests that clinicians can have some confidence in the specific language intervention practices examined. Conclusion: The fact that only 21 studies met our criteria means that there is relatively little evidence supporting the language intervention practices that are currently being used with school-age children with language disorders. We outline significant gaps in the evidence and discuss the implications for clinical practice in schools

Evidence-Based Systematic Review: Effects of Different Service Delivery Models on Communication Outcomes for Elementary School–Age Children

Purpose: The purpose of this investigation was to conduct an evidence-based systematic review (EBSR) of peer-reviewed articles from the last 30 years about the effect of different service delivery models on speech-language intervention outcomes for elementary school–age students. Method: A computer search of electronic databases was conducted to identify studies that addressed any of 16 research questions. Structured review procedures were used to select and evaluate data-based studies that used experimental designs of the following types: randomized clinical trial, nonrandomized comparison study, and single-subject design study. Results: The EBSR revealed a total of 5 studies that met the review criteria and addressed questions of the effectiveness of pullout, classroom-based, and indirect–consultative service delivery models with elementary school–age children. Some evidence suggests that classroom-based direct services are at least as effective as pullout intervention for some intervention goals, and that highly trained speech-language pathology assistants, using manuals prepared by speech-language pathologists to guide intervention, can provide effective services for some children with language problems. Conclusion: Lacking adequate research-based evidence, clinicians must rely on reason-based practice and their own data until more data become available concerning which service delivery models are most effective. Recommendations are made for an expanded research agenda

Evidence-Based Systematic Review: Effects of Different Service Delivery Models on Communication Outcomes for Elementary School–Age Children

Purpose: The purpose of this investigation was to conduct an evidence-based systematic review (EBSR) of peer-reviewed articles from the last 30 years about the effect of different service delivery models on speech-language intervention outcomes for elementary school–age students. Method: A computer search of electronic databases was conducted to identify studies that addressed any of 16 research questions. Structured review procedures were used to select and evaluate data-based studies that used experimental designs of the following types: randomized clinical trial, nonrandomized comparison study, and single-subject design study. Results: The EBSR revealed a total of 5 studies that met the review criteria and addressed questions of the effectiveness of pullout, classroom-based, and indirect–consultative service delivery models with elementary school–age children. Some evidence suggests that classroom-based direct services are at least as effective as pullout intervention for some intervention goals, and that highly trained speech-language pathology assistants, using manuals prepared by speech-language pathologists to guide intervention, can provide effective services for some children with language problems. Conclusion: Lacking adequate research-based evidence, clinicians must rely on reason-based practice and their own data until more data become available concerning which service delivery models are most effective. Recommendations are made for an expanded research agenda