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

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

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

Validity of the Communication Function Classification System for use with preschool children with communication disorders

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 (Time 2), and at the end of treatment (Time 3). Results: There was a significant negative correlation between CFCS classifications and FOCUS© scores at all three measurement points for the ratings by both parents and SLPs (correlations ranged from -.60 to -.76). As expected, no correlations between CFCS classifications and FOCUS© change scores were statistically significant. Interpretation: This study provides evidence of construct and predictive validity of the CFCS, demonstrating its value as a discriminative tool for use with preschoolers with a range of speech and language disorders

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

Factors Contributing to Preschoolers\u27 Communicative Participation Outcomes: Findings From a Population-Based Longitudinal Cohort Study in Ontario, Canada

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 outcomes. Clinically significant predictors included participation in an early learning environment, receipt of speech-language interventions, and the amount of time spent in intervention. These variables impacted predicted outcomes differently depending on a child’s level of communicative function. Conclusions. This population-based study of preschoolers with speech and language disorders identified predictors of growth in communicative participation skills – an outcome important and meaningful to families but, not often explored. A broad picture emerged of factors that may influence the development of communicative participation skills, and may be used to predict outcomes for preschoolers. Given the large sample size, these robust findings may be used to predict outcomes outside the PSLP as well

Person-centered Outcomes in Culturally and Diverse Contexts: International Application of the ICF

This session is developed by, and presenters invited by, Cultural and Linguistic Considerations Across the Discipline. This session was developed by the Convention Program Committee to increase SLPs’ awareness regarding research and clinical applications of the International Classification of Functioning, Disability and Health (ICF) across pediatric and adult populations around the world. Discussants provide perspectives from Australia, Brazil, Canada, Jamaica, and the United States

Personal commitment statements : encouraging the clinical application of continuing professional development events for health practitioners in low- and middle-income countries

INTRODUCTION : Statements of commitment to change are commonly used to evaluate continuing medical education. However, this approach is new to evaluating the continuing professional development (CPD) of other health care practitioners such as audiology, speech-language therapy, occupational therapy, and physiotherapy in low- and middle-income countries. This study explored the use of Personal Commitment (to change) Statements (PCSs) as an evaluation tool of continuing education for health professionals in low- and middle-income countries, and its impact on the integration of new knowledge and skills with previous knowledge and clinical practice. METHODS : PCSs were used in a case study conducted at a 1-day interprofessional CPD event held for health practitioners in South Africa. A qualitative thematic analysis was made of these PCSs, and results were synthesized into main themes. RESULTS : Thirty-two participants turned in a PCS at the end of the CPD event with a total of 71 text statements. Three main domains were identified: (1) applying new knowledge in practice (61.97%); (2) increasing training-related content knowledge (21.12%); and (3) sharing information, skill, and resources (16.9%). DISCUSSION : This study demonstrated that personal commitment statements can be used to describe the outcomes of CPD events for audiologists, speech-language, occupational, and physiotherapists. Participants engaged in reflection generated by the personal commitment statement, which contained no guiding statements, yet elicited responses showing that participants were more aware of the assessment tools and how they could use them in practice. Further study is warranted into the process and the role of follow-up regarding health practitioners' commitment to change in clinical practice.The Carnegie African Diaspora Fellowship (ADF) Program and University of Pretoria's Research Office.https://www.jcehp.org2020-04-01hj2019Centre for Augmentative and Alternative Communication (CAAC

Dysautonomia rating scales in Parkinson's disease: Sialorrhea, dysphagia, and constipation—

Upper and lower gastrointestinal dysautonomia symptoms (GIDS)—sialorrhea, dysphagia, and constipation are common in Parkinson's disease (PD) and often socially as well as physically disabling for patients. Available invasive quantitative measures for assessing these symptoms and their response to therapy are time-consuming, require specialized equipment, can cause patient discomfort and present patients with risk. The Movement Disorders Society commissioned a task force to assess available clinical rating scales, critique their clinimetric properties, and make recommendations regarding their clinical utility. Six clinical researchers and a biostatistician systematically searched the literature for scales of sialorrhea, dysphagia, and constipation, evaluated the scales' previous use, performance parameters, and quality of validation data (if available). A scale was designated “Recommended” if the scale was used in clinical studies beyond the group that developed it, has been specifically used in PD reports, and clinimetric studies have established that it is a valid, reliable, and sensitive. “Suggested” scales met at least part of the above criteria, but fell short of meeting all. Based on the systematic review, scales for individual symptoms of sialorrhea, dysphagia, and constipation were identified along with three global scales that include these symptoms in the context of assessing dysautonomia or nonmotor symptoms. Three sialorrhea scales met criteria for Suggested: Drooling Severity and Frequency Scale (DSFS), Drooling Rating Scale, and Sialorrhea Clinical Scale for PD (SCS-PD). Two dysphagia scales, the Swallowing Disturbance Questionnaire (SDQ) and Dysphagia-Specific Quality of Life (SWAL-QOL), met criteria for Suggested. Although Rome III constipation module is widely accepted in the gastroenterology community, and the earlier version from the Rome II criteria has been used in a single study of PD patients, neither met criteria for Suggested or Recommended. Among the global scales, the Scales for Outcomes in PD-Autonomic (SCOPA-AUT) and Nonmotor Symptoms Questionnaire for PD (NMSQuest) both met criteria for Recommended, and the Nonmotor Symptoms Scale (NMSS) met criteria for Suggested; however, none specifically focuses on the target gastrointestinal symptoms (sialorrhea, dysphagia, and constipation) of this report. A very small number of rating scales have been applied to studies of gastrointestinal-related dysautonomia in PD. Only two scales met “Recommended” criteria and neither focuses specifically on the symptoms of sialorrhea, dysphagia, and constipation. Further scale testing in PD among the scales that focus on these symptoms is warranted, and no new scales are needed until the available scales are fully tested clinimetrically. © 2009 Movement Disorder SocietyPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/62130/1/22260_ftp.pd