Language Speech and Hearing Services in Schools最新文献

Purpose: This purpose of this prologue is to introduce readers to the Language, Speech, and Hearing Services in Schools Forum: Minding the Gap: Using Implementation Science to Improve Clinical Practice in Schools. Ten articles comprise this forum presenting a variety of topics, such as the use of implementation science frameworks and methods, program adaptation, de-implementation, and interprofessional collaboration.

Conclusion: As showcased in this forum, implementation science offers many ways to bridge the gap between research and practice and improve school-based services for children with communication disorders.

Purpose: The purpose of this study was to compare child language assessment practices of speech-language pathologists (SLPs) working in school and nonschool settings to determine if their place of employment impacts the diagnostic decision-making process.

Method: School-based SLPs (e.g., direct service providers employed in preschool and/or K-12 schools; n = 382) and non-school-based SLPs (e.g., direct service providers employed in private practices, university clinics, and/or medical settings; n = 147) completed a web-based questionnaire. The questionnaire examined the types, frequency, and perceived importance of specific assessment tools and potential workplace factors that may impact their diagnostic decision-making process.

Results: Both school-based and non-school-based SLPs reported using a combination of assessment tools when evaluating children with potential language disorders. School-based SLPs tended to rank the frequency of use and importance of most assessment tools similarly, while non-school-based SLPs ranked interviews as the most frequently used and most important assessment tool. Statistically significant group differences indicated that school-based SLPs ranked the frequency of use and importance of standardized testing higher compared to their non-school-based counterparts. Also, school-based SLPs rated employment-based factors impacting diagnostic decision making higher compared to non-school-based SLPs.

Conclusions: SLPs practicing in school-based settings seem to handle more employment-based factors that impact independent diagnostic decision making than SLPs working in different employment settings when assessing children for potential language disorders. Clinical recommendations are provided, and implications for implementation-based assessment research in child language are discussed.

Purpose: One of our biggest challenges is integrating evidence-based research into practice to serve students with communication disorders. To encourage the systematic application of research findings into practice, implementation science offers frameworks and tools, many of which have a narrow scope. It is important to have comprehensive frameworks that encompass all essential implementation concepts to support implementation in schools.

Method: Guided by the generic implementation framework (GIF; Moullin et al., 2015), we reviewed implementation science literature to identify and tailor frameworks and tools covering all core concepts of implementation: (a) the process of implementation, (b) the domains and determinants of practice, (c) implementation strategies, and (d) evaluations.

Results: We created a version of the GIF for school settings, called the GIF-School, to bring together frameworks and tools that sufficiently cover core concepts of implementation. The GIF-School is accompanied by an open access toolkit, which lists selected frameworks, tools, and useful resources.

Conclusion: Researchers and practitioners, in speech-language pathology and education more broadly, who seek to apply implementation science frameworks and tools to improve school services for students with communication disorders may turn to the GIF-School as a resource.

Supplemental material: https://doi.org/10.23641/asha.23605269.

Purpose: Narrative abilities are an important part of everyday conversation, playing a key role in academic settings, at home, and in social interactions. As narrative assessments are an effective method for identifying children falling below age expectations, it has been recommended they be included as a routine part of clinical language assessments. It is important that assessments meet the needs of clinicians and their practice. The current study is a practice-based research partnership, where research questions arose from a partnership with school-based speech-language pathologists (SLPs). Working together, SLPs and researchers evaluated a bespoke narrative retell assessment tool. The current study examined recall of events in two wordless picture books, in order to evaluate story equivalency and determine if the tool was appropriate for progress monitoring. These findings were then used to develop local norms.

Method: Two hundred sixty-three students were recruited across 12 schools in kindergarten, Grade 1, and Grade 2. Students completed the narrative retell task, retelling either One Frog Too Many or Frog Goes to Dinner, followed by answering 10 comprehension questions related to story events.

Results: A significant effect of story was found for both main and supporting events recalled, but not for total events recalled. Total events recalled were found to be predicted by grade only. An examination of percent events recalled revealed four main and four supporting events in each story that were potentially misclassified. Reanalysis following reallocation revealed no significant effect of story for main or supporting events recalled. Normative values for each grade were created using percentile ranks of total events recalled.

Conclusion: Through a practice-based research partnership, researchers and clinicians worked collaboratively to evaluate a tool, adapt its use, and improve evidence-based practice in a manner that was appropriate and met the needs for the clinical context.

Purpose: Developmental language disorder (DLD) is an underidentified neurodevelopmental disorder that affects, on average, one out of 11 kindergarten-age children (ages 4-6 years). Children with DLD can face academic, behavioral, psychiatric, emotional, and social challenges. Universal screening is seen as an effective way for public school districts to increase DLD identification rates. However, little is known about factors impacting implementation of school-based universal screenings for DLD. We partnered with a large suburban school district in the Intermountain West region of the United States to gather detailed perspectives from school personnel regarding the barriers and facilitators to the implementation of universal screening in their district.

Method: Using a two-phase mixed-methods design, we first conducted focus groups to identify potential barriers and facilitators to universal screening. We then used the qualitative data from the first phase to develop a 20-item survey to assess agreement with the focus group results among a wider group of district speech-language pathologists and kindergarten teachers from the school district.

Results: Our survey showed moderate levels of agreement with our focus group results. In particular, school personnel showed high levels of support for universal screening for DLD, with interesting interplay across various factors: (a) the negative impact of unmanageable workload on personnel under both referral- and universal-based identification formats, (b) the preference for paraprofessionals to administer screenings, (c) the role that Response to Intervention programs may play in offsetting workloads associated with universal screenings, and (d) the need for increased awareness and education about child language development and impairment among general education teachers and the public.

Conclusion: Recommendations for incorporating these factors into more useful and applicable collaborative research-based efforts are presented.

Supplemental material: https://doi.org/10.23641/asha.23661876.

Purpose: This study investigated the effects of Sketch and Speak strategy intervention on expressive and receptive expository discourse for adolescents with language-related learning disabilities (LLD).

Method: Three participants completed baseline and twelve 45- to 60-min individual treatment sessions in a multiple-baseline across participants design. In treatment, participants learned to take notes using pictography and conventional bulleted notes, orally generate sentences from their notes, and orally practice full sentences and oral reports. Session tests with varied levels of instructional support were used to collect outcome data on free-recall oral reports, short-answer question responses, and participant notes. A distal, age- referenced expository task and social validity questionnaires were administered pre-/postintervention.

Results: Visual and statistical analyses revealed significant effects of treatment on the primary outcome measure of Oral Report Quality and on secondary outcomes of Note Quantity and Quality. There was no significant effect of treatment on Short-Answer Recall questions. Two participants generalized strategies during the treatment phase to independent performance on Oral Reports and one improved on Note Quality. All three participants improved on the distal expository measure. Social validity questionnaires showed participant awareness and buy-in of taught strategies, with potential for generalization at the high school level.

Conclusions: These adolescent students benefited from explicit instruction in note-taking strategies and systematic oral practice of expository discourse even within the challenging delivery setting of telepractice. This study provides evidence for the use of Sketch and Speak expository intervention with adolescents with LLD to improve comprehension and expression of grade-level material.

Supplemental material: https://doi.org/10.23641/asha.23681505.

Purpose: This clinical focus article follows the case studies of three school-age children who stutter in solution-focused brief therapy (SFBT), highlighting treatment features and demonstrating positive outcomes. Empowerment and self-agency are emphasized as desired characteristics. Children searched within themselves and acted to influence therapy results. Techniques such as self-disclosure and fluency shaping were incorporated into this approach.

Method: In a public school district, participants with moderate-to-severe stuttering used the Clinical Use of Self-Reports to measure their perceived stuttering severity across various contexts and audiences. The speech-language pathologist (SLP) provided verbal feedback/contingencies including personalized questions, supportive statements, and positive gestures/comments. The students identified a stuttering problem, implemented the suggested techniques in clinic and in their natural environments, and shared pertinent feedback during the following therapy sessions.

Results: Participants solved stuttering problems and took charge of their own treatment. After 5 weeks of SFBT, the 18-year-old demonstrated sufficient problem-solving skills to agree to be discharged from the program. The remaining two students exhibited growth toward their individualized goals. They showed curiosity about their own stuttering situations and applied innovative strategies, in the outside world, that had been practiced and formulated in their therapy sessions.

Conclusions: The participants engaged in conversations with the SLP, teachers, peers, and family members. They documented conversations, reflections, performance scales, and personal goals in their journals. During therapy sessions, the children clarified real-life goals and tried out techniques for managing their stuttering difficulties. In addition, they completed the Clinical Use of Self-Reports to assess their communication values, successes, and challenges.

Supplemental material: https://doi.org/10.23641/asha.23706363.

Purpose: It is often difficult for school-based speech-language pathologists (SLPs) to prioritize implementing new practices for children with speech sound disorders (SSDs), given burgeoning caseloads and the myriad of other workload tasks. We propose that de-implementation science is equally as important as implementation science. De-implementation science is the recognition and identification of areas that are of "low-value and wasteful." Critically, the idea of de-implementation suggests that we first remove something from a clinician's workload before requesting that they learn and implement something new.

Method: Situated within the Sustainability in Healthcare by Allocating Resources Effectively (SHARE) framework, we review de-implementation science and current speech sound therapy literature to understand the mechanisms behind continuous use of practices that are no longer supported by science or legislation. We use vignettes to highlight real-life examples that clinicians may be facing in school-based settings and to provide hypothetical solutions, resources, and/or next steps to these common challenges.

Results: By focusing on Phase 1 of the SHARE framework, we identified four primary practices that can be de-implemented to make space for new evidence-based techniques and approaches. These four practices were determined based on an in-depth review of SLP-based survey research: (a) overreliance on speech sound norms for eligibility determinations, (b) the omission of phonological processing skills within evaluations, (c) homogeneity of service delivery factors, and (d) the use of only one treatment approach for all children with SSDs.

Conclusions: De-implementation will take work and may lead to some difficult discussions. Implementing a framework, such as SHARE, can guide SLPs toward a reduction in workloads and improved outcomes for children with SSDs.

Purpose: The aim of this study was to map the use of implementation science frameworks, models, and theories in intervention research targeting learning needs in the classroom.

Method: A scoping review was conducted. Electronic database and manual searches were conducted. Two reviewers independently completed screening, data extraction, and quality appraisal. Qualitative content analysis was undertaken using Nilsen's taxonomy and the domains of the Consolidated Framework for Implementation Research (CFIR). The data were further analyzed using the CFIR valence and strength rating scales.

Results: Included papers (n = 22) used a diverse sample of implementation science frameworks and models. Most studies used determinant frameworks to guide data collection and analysis. Few studies used implementation science theory. Most studies were mixed methods (n = 11), published since 2019 (n = 20), and conducted in North America (n = 15). Over half of the interventions targeted social, emotional, and mental health (n = 13). A complex interplay of inner setting factors was identified as having a strong influence on implementation. Teachers' knowledge and beliefs, adaptability, and complexity of interventions were also identified as important considerations when conducting research in this context.

Conclusions: Early engagement with stakeholders in education is recommended when designing universal level speech, language, and communication interventions for use in the ordinary classroom. Adaptive, hybrid designs that test both implementation strategies and effectiveness of interventions may be warranted given the influence of inner setting factors on implementation outcomes.

Purpose: Children who are deaf and hard of hearing (DHH) have documented deficits with complex syntax and vocabulary knowledge. Mental state verbs (MSVs) are necessary for some kinds of complex syntax use and communicate abstract concepts needed for academic language. The purpose of this study was to examine the frequency, diversity, and syntactic context of MSV use in children who are DHH compared to children with typical hearing (CTH).

Method: Seventy-three preschool children (23 with cochlear implants, 22 with hearing aids, and 28 with typical hearing) completed a structured language sample as part of a larger assessment battery. Samples were analyzed and compared across groups for use of MSVs, diversity in MSV use, and syntactical context for MSVs.

Results: Children who are DHH used significantly fewer MSV in complex syntax, a smaller diversity of MSV, and significantly fewer MSV in obligatory contexts compared to CTH. Results for the cochlear implants and hearing aid groups were not significantly different from one another despite differing levels of hearing loss.

Conclusion: Children who are DHH demonstrate significant differences in the rate, diversity, and complexity of MSV use compared to peers with typical hearing.

Supplemental material: https://doi.org/10.23641/asha.24091860.