American Speech-Language-Hearing Association Clinical Practice Guideline on Aural Rehabilitation for Adults With Hearing Loss.

BACKGROUND: Hearing loss poses a significant public health challenge as a common chronic condition with many known side effects that are often worse when left untreated. Aural rehabilitation (AR) is an umbrella term that encompasses a range of interventions (e.g., informational counseling and perceptual training) designed to reduce deficits related to hearing loss that may stand alone or be used in combination as part of a holistic plan. PURPOSE: This evidence-based clinical practice guideline is intended to inform the implementation of person-centered AR to adults with hearing loss. Given the well-known benefits of sensory management, it was not included within the scope of this guideline. The recommendations aim to help clinicians, individuals with hearing loss, and other stakeholders make evidence-informed treatment decisions and improve clinical outcomes, as well as provide payers and policymakers with information detailing a comprehensive approach to AR. METHOD: The American Speech-Language-Hearing Association (ASHA) and a multidisciplinary panel of subject matter experts prioritized key clinical questions and outcomes that served as the foundation of the guideline. The clinical recommendations were based on a comprehensive systematic review and a meta-analysis of 85 studies published between 1978 and 2021. RECOMMENDATIONS: Given the current state of the evidence, resource considerations, patient acceptability, clinical feasibility, and the overall balance of benefits and harms, ASHA developed several evidence-based recommendations for the provision of AR to adults with hearing loss. Each recommendation is accompanied by a series of key practice points to support its implementation within a person-centered framework.

American Speech-Language-Hearing Association Clinical Practice Guideline: Cognitive Rehabilitation for the Management of Cognitive Dysfunction Associated With Acquired Brain Injury.

BACKGROUND: Cognitive-communication impairments following acquired brain injury (ABI) can have devastating effects on a person's ability to participate in community, social, vocational, and academic preinjury roles and responsibilities. Guidelines for evidence-based practices are needed to assist speech-language pathologists (SLPs) and other rehabilitation specialists in the delivery of cognitive rehabilitation for the adult population. PURPOSE: The American Speech-Language-Hearing Association, in conjunction with a multidisciplinary panel of subject matter experts, developed this guideline to identify best practice recommendations for the delivery of cognitive rehabilitation to adults with cognitive dysfunction associated with ABI. METHOD: A multidisciplinary panel identified 19 critical questions to be addressed in the guideline. Literature published between 1980 and 2020 was identified based on a set of a priori inclusion/exclusion criteria, and main findings were pooled and organized into summary of findings tables. Following the principles of the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision Framework, the panel drafted recommendations, when appropriate, based on the findings, overall quality of the evidence, balance of benefits and harms, patient preferences, resource implications, and the feasibility and acceptability of cognitive rehabilitation. RECOMMENDATIONS: This guideline includes one overarching evidence-based recommendation that addresses the management of cognitive dysfunction following ABI and 11 subsequent recommendations focusing on cognitive rehabilitation treatment approaches, methods, and manner of delivery. In addition, this guideline includes an overarching consensus-based recommendation and seven additional consensus recommendations highlighting the role of the SLP in the screening, assessment, and treatment of adults with cognitive dysfunction associated with ABI. Future research considerations are also discussed.

Ethical Responsibilities to Adults with Communication Impairments Involved in Group Therapy.

Ethical challenges can arise when providing group therapy to adults living with communication impairments. In addition to the ethical challenges that may be encountered when conducting one-to-one therapy intervention, practitioners must also consider dilemmas that are specific to group therapy. This article considers the principles and rules of the American Speech-Language-Hearing Association (ASHA) Code of Ethics via a series of clinical vignettes that illustrate four ethical challenges that may be encountered when providing group therapy: acquiring sufficient clinical competency to conduct group therapy; handling issues related to client confidentiality; resisting external pressure to provide groups solely for financial gain and/or other administrative efficiencies; and handling practitioner-client boundaries.

Ethical Considerations for Healthcare Organizations.

Ethical misbehavior in the delivery of healthcare creates harm not only to individual therapists and administrators who might choose to overstep ethical boundaries but also, more broadly, causes harm to patients, to healthcare organizations, to professional organizations, and ultimately to society. Both corporate codes of conduct and professional codes of ethics are important, because they set standards of conduct and penalize noncompliant or unethical conduct. The purposes of this article are (1) to differentiate corporate compliance from ethics in a healthcare organization; (2) to explain the application of ethics principles to organizational and professional behaviors; (3) to discuss three important ethical issues (cultural competence, conflict of interest, and employer demands); and (4) to emphasize that, whether applying a corporate code of conduct or a professional code of ethics (or both), the integrity of each individual is essential to ethical behavior. To illustrate these concepts, ASHA's Code of Ethics is discussed in detail (including the ethics complaint adjudication process), and hypothetical case studies are presented under the macro headings of Cultural Competence, Conflict of Interest, and Employer Demands.

Implementation and Perceptions of Classroom-Based Service Delivery: A Survey of Public School Clinicians.

Purpose The choice of service delivery model is important for public school clinicians. Despite a theoretical emphasis on inclusive classroom-based services, data from a recent American Speech-Language-Hearing Association Schools Survey indicated that the pullout model is still the more frequently used approach (American Speech-Language-Hearing Association, 2016). In the current study, public school clinicians' use and perceptions of inclusion were examined to better understand potential influences on its implementation. Method Three hundred forty-four school-based clinicians completed an online survey about their training in and implementation of inclusion services, along with their perceptions of positive and potentially challenging aspects of this model. Descriptive data were examined, and the relationships of use and perceptions to issues such as caseload size, training, school setting, teacher factors, and administrative support were analyzed. Additionally, qualitative analysis was used to examine responses to 3 open-ended questions. Results Over half of the respondents served 1%-25% of their caseload through an inclusion model, and it was most frequently utilized to address language and social skills. Teacher collaboration and planning time were the 2 most frequently reported keys to inclusion success and were also 2 of the most frequently reported challenges to implementation. Conclusions The majority of the respondents reported many positive aspects of inclusion, yet they also reported many of the same challenging perceptions and roadblocks that existed when speech-language pathologists were surveyed over 20 years ago. Based on the results of this study, training in the inclusion model, teacher "buy-in," planning time, and administrative support are relevant to successful use of classroom-based intervention.

Principles and Ethics of Authorship.

Purpose Rules and ethics of authorship for scientific papers are reviewed. Those authorship criteria specific to American Speech-Language-Hearing Association journals are reviewed as well as those required by journals in related fields. Conclusions The importance of first author status for students publishing their doctoral dissertation research is stressed as well as the need to discuss and resolve authorship status for all investigators early in the research process. The authorship criteria for the journal of choice are mandatory, and this necessitates educating all authors regarding the existing requirements.

Resources for LSHSS Authors.

Purpose: In this article, the Editor-in-Chief of Language, Speech, and Hearing Services in Schools (LSHSS) highlights key resources for authors wishing to publish their work in LSHSS.

Bilingual Language Assessment: Contemporary Versus Recommended Practice in American Schools.

PURPOSE: The purpose of this study was to identify current practices of school-based speech-language pathologists (SLPs) in the United States for bilingual language assessment and compare them to American Speech-Language-Hearing Association (ASHA) best practice guidelines and mandates of the Individuals with Disabilities Education Act (IDEA, 2004). METHOD: The study was modeled to replicate portions of Caesar and Kohler's (2007) study and expanded to include a nationally representative sample. A total of 166 respondents completed an electronic survey. RESULTS: Results indicated that the majority of respondents have performed bilingual language assessments. Furthermore, the most frequently used informal and standardized assessments were identified. SLPs identified supports, and barriers to assessment, as well as their perceptions of graduate preparation. CONCLUSION: The findings of this study demonstrated that although SLPs have become more compliant to ASHA and IDEA guidelines, there is room for improvement in terms of adequate training in bilingual language assessment.

Use of Language Sample Analysis by School-Based SLPs: Results of a Nationwide Survey.

PURPOSE: This article examines use of language sample analysis (LSA) by school-based speech-language pathologists (SLPs), including characteristics of language samples, methods of transcription and analysis, barriers to LSA use, and factors affecting LSA use, such as American Speech-Language-Hearing Association certification, number of years' experience, and caseload characteristics. METHOD: School-based SLPs responded to an invitation to complete an electronic survey related to LSA. RESULTS: One third of respondents indicated they did not use LSA during the 2012-2013 school year. SLPs who served middle and high school students were less likely to use LSA. Most respondents reported using conversation to analyze fewer than 10 samples and transcribing in real time. Additional analyses revealed that SLPs who had 3 or fewer years of experience and who analyzed fewer than 20 language samples per year were statistically less likely to report using real-time transcription. The most frequently cited barrier to using LSA was "LSA is too time-consuming." CONCLUSION: Many school-based SLPs do not routinely use LSA. Further, many did not report engaging in evidence-based practices, such as recording samples, using established protocols, or using tasks designed to elicit complex syntax. These results indicate a continued need for professional development regarding evidenced-based practices relative to LSA use.

Dysphagia Practice in 2035: Beyond Fluorography, Thickener, and Electrical Stimulation.

Dysphagia evaluation and management has rapidly become the primary practice area of medical speech pathologists since its adoption in our field less than three decades ago. As a specialty, swallowing and swallowing disorders comprise the largest represented discipline with 10,059 specialty interest group members within the American Speech-Language-Hearing Association and 298 board-certified specialists in the American Speech Hearing Association. There are national and international organizations, such as the Dysphagia Research Society and its interdisciplinary journal Dysphagia, that provide continuing education for clinicians and a platform for dysphagia researchers. Despite this rapid growth, herein we identify some significant needs for improving the science and practice of dysphagia clinical care, including a deeper understanding of physiology and neurophysiology, standardization of evaluation, consensus on core sets of dysphagia parameters for clinical and research reporting, personalized algorithms for implementation of evidenced-based practice, metrics for therapy efficacy, and increased buy-in and funding from agencies. The goals of this article are to summarize the status quo of dysphagia research, evaluation, and treatment as well as to make predictions about the future. Medical trends that we speculate will influence dysphagia research and care in the future include, among others, imaging advances, personalized medicine, regenerative medicine, and telehealth.

School-Based Speech-Language Pathologists' Knowledge and Perceptions of Autism Spectrum Disorder and Bullying.

PURPOSE: The purpose of the current investigation was to examine speech-language pathologists' (SLPs') knowledge and perceptions of bullying, with an emphasis on autism spectrum disorder (ASD). METHOD: A 46-item, web-based survey was used to address the purposes of this investigation. Participants were recruited through e-mail and electronic mailing lists for American Speech-Language-Hearing Association (ASHA) special interest divisions 1 (Language, Learning, and Education) and 16 (School-Based Issues). Also, an embedded link to the survey was posted on the ASHA Community website and ASHA Facebook page. RESULTS: Participants demonstrated knowledge of many aspects of bullying research; however, they demonstrated weaknesses in others. All respondents agreed that SLPs should intervene in moments of bullying, but not all indicated that they feel comfortable intervening. Few participants indicated that their school district implemented antibullying campaigns specific to children with special needs, such as ASD. CONCLUSIONS: As recognized experts in working with children with communication deficits, including individuals with ASD, SLPs have the opportunity to play a key role in antibullying efforts. Results revealed, however, that school-based SLPs may benefit from more information on bullying in order to understand the nature, context, and extent of this issue, as well as ways in which to respond to bullying when it is observed.

Clinical Decision Making in Skilled Nursing/Long-Term Care: Using and Generating Evidence in the Field.

In this article, setting-specific challenges and recent ethical concerns relating to speech-language pathology service provision in skilled nursing/long-term care are discussed in the context of implementing evidence-based practice (EBP). The American Speech-Language-Hearing Association's four-step EBP process is reviewed, and barriers to and limitations of EBP are considered. Resources established by experts in various domains for accessing and efficiently evaluating evidence are provided. Guiding principles of medical ethics are reviewed as foundational elements of patient-centered care, and systematic treatment design practices are offered as means of generating practice-based evidence, which allows for assessment of intervention efficacy and complements the EBP process. Last, the integration of all steps of the EBP model is illustrated in a case study of a patient with moderate to severe hypokinetic dysarthria and comorbidities. It is hoped that these resources, principles, and practices will be of use to clinicians specifically in the skilled nursing facility/ long-term care setting in the provision of high-quality speech-language pathology interventions.

Speech, language, hearing delays: time for early intervention?

A wait-and-see approach may not be best for the child exhibiting delayed development. This review--complete with extensive resource lists--can facilitate an expeditious referral.

Educating globally conscious speech-language pathologists for collaborative professional practice.

Speech-language pathologists (SLPs) practicing in the US are facing significant changes in reimbursement, billing and practice in both health care and educational settings. Health care professionals need to convey and demonstrate the value of their services, measure functional patient outcomes and assess patient satisfaction. Documentation procedures for patient and student progress are changing, becoming more abbreviated and electronic. The content of curricula in accredited graduate programs and professional development programs for maintenance of certification for SLPs will need modifications to address the myriad of changes in clinical practice. University programs that design interprofessional education opportunities for students in speech-language pathology programs and educate students in other health professional programs, e.g. physical therapy, occupational therapy, nursing and pharmacy, will help practitioners who are prepared to engage in collaborative practice with other health care professionals in hospitals, schools and community-based environments. The American Speech-Language-Hearing Association (ASHA) is actively engaged in several initiatives to facilitate interprofessional education for graduate students, faculties and practicing professionals. Individuals and families with communication disorders in the US represent an array of cultures, and SLPs need to be prepared to work effectively with individuals from different cultural and linguistic backgrounds.

Evidence-based speech-language pathology practices in schools: findings from a national survey.

PURPOSE: This study documented evidence-based practice (EBP) patterns as reported by speech-language pathologists (SLPs) employed in public schools during 2010-2011. METHOD: Using an online survey, practioners reported their EBP training experiences, resources available in their workplaces, and the frequency with which they engage in specific EBP activities, as well as their resource needs and future training format preferences. RESULTS: A total of 2,762 SLPs in 28 states participated in the online survey, 85% of whom reported holding the Certificate of Clinical Competence in Speech-Language Pathology credential. Results revealed that one quarter of survey respondents had no formal training in EBP, 11% of SLPs worked in school districts with official EBP procedural guidelines, and 91% had no scheduled time to support EBP activities. The majority of SLPs posed and researched 0 to 2 EBP questions per year and read 0 to 4 American Speech-Language-Hearing Association (ASHA) journal articles per year on either assessment or intervention topics. CONCLUSION: Use of ASHA online resources and engagement in EBP activities were documented to be low. However, results also revealed that school-based SLPs have high interest in additional training and resources to support scientifically based practices. Suggestions for enhancing EBP support in public schools and augmenting knowledge transfer are provided.

Evidence-based clinical voice assessment: a systematic review.

PURPOSE: To determine what research evidence exists to support the use of voice measures in the clinical assessment of patients with voice disorders. METHOD: The American Speech-Language-Hearing Association (ASHA) National Center for Evidence-Based Practice in Communication Disorders staff searched 29 databases for peer-reviewed English-language articles between January 1930 and April 2009 that included key words pertaining to objective and subjective voice measures, voice disorders, and diagnostic accuracy. The identified articles were systematically assessed by an ASHA-appointed committee employing a modification of the critical appraisal of diagnostic evidence rating system. RESULTS: One hundred articles met the search criteria. The majority of studies investigated acoustic measures (60%) and focused on how well a test method identified the presence or absence of a voice disorder (78%). Only 17 of the 100 articles were judged to contain adequate evidence for the measures studied to be formally considered for inclusion in clinical voice assessment. CONCLUSION: Results provide evidence for selected acoustic, laryngeal imaging-based, auditory-perceptual, functional, and aerodynamic measures to be used as effective components in a clinical voice evaluation. However, there is clearly a pressing need for further high-quality research to produce sufficient evidence on which to recommend a comprehensive set of methods for a standard clinical voice evaluation.

Language use in social interactions of school-age children with language impairments: an evidence-based systematic review of treatment.

INTRODUCTION: Pragmatic models were first applied to the treatment of children with language impairment in the late 1970s. Since that time, the study of language use has had considerable impact on language assessment and treatment. Despite the need to address pragmatic language skills clinically, there has been no systematic examination of the efficacy of treatments developed for this purpose. METHOD: In accordance with the evidence-based practice policy agenda, the American Speech-Language-Hearing Association (ASHA) convened an ad hoc committee on language use in social interactions in school-age children. The committee's charge was to develop an evidence-based systematic review of treatment for disorders of language use in social interactions. This charge was conducted in collaboration with ASHA's National Center for Evidence-Based Practice in Communication Disorders. RESULTS: This systematic review provided preliminary support for the feasibility of various treatment procedures addressing social communication behaviors. Gains were reported in topic management skills, narrative production, and repairs of inadequate or ambiguous comments. CONCLUSION: Because further investigation of these treatments is warranted, the committee is unable to make empirically supported recommendations for changes in standard clinical practice based solely on this review. More research is needed to examine the feasibility of interventions that focus on children's language use.

Ethical issues in a pediatric private practice.

Building a successful pediatric private practice requires clinical expertise and an understanding of the business process, as well as familiarity with the American Speech-Language-Hearing Association Code of Ethics. This article provides an overview of the ethical issues that may be encountered when building a practice, including a look at marketing and advertising, financial management, privacy, and documentation. Ethically sound decision making is a key to a successful business.