School-Based Speech-Language Pathologists' Adherence to Practice Guidelines for Assessment of English Learners.

Purpose The purpose of this study was to ascertain the extent to which school-based speech-language pathologists' (SLPs) assessment practices with individual English learners (ELs) align with federal legislation and professional practice guidelines. Specifically, we were interested in examining SLPs' use of multiple tools during individual EL assessments, as well as relationships between practices and number of types of training experiences. Method School-based SLPs in a Midwestern state were recruited in person or via e-mail to complete an online survey pertaining to assessment. Of the 562 respondents who completed the survey, 222 (39.5%) indicated past or present experience with ELs, and thus, their data were included in the analyses. The questionnaire solicited information about respondent's demographics, caseload composition, perceived knowledge and skills and training experiences pertaining to working with ELs (e.g., graduate school, self-teaching, professional conferences), and assessment practices used in schools. Results The majority of respondents reported using multiple tools rather than a single tool with each EL they assess. Case history and observation were tools used often or always by the largest number of participants. SLPs who used multiple tools reported using both direct (e.g., standardized tests, dynamic assessment) and indirect tools (e.g., case history, interviews). Analyses revealed low to moderate positive associations between tools, as well as the use of speech-language samples and number of types of training experiences. Conclusions School-based SLPs in the current study reported using EL assessment practices that comply with federal legislation and professional practice guidelines for EL assessment. These results enhance our understanding of school-based SLPs' assessment practices with ELs and may be indicative of a positive shift toward evidence-based practice.

Stuttering Practice Self-Assessment by School Speech-Language Practitioners.

Purpose The purpose of this study was to survey school speech-language practitioners' self-perceptions of their confidence, knowledge, and need for support for working with school-age students who stutter (SWS). Method A total of 120 school-based speech-language practitioners from 27 Nashville, Tennessee, area counties completed an online, 35-item survey examining caseloads, coursework, continuing education, experience, and perceived levels of skill and confidence in service provision to SWS. They also rated their need for consultation from speech-language pathologists who specialize in stuttering to improve their skills with SWS. Results Respondents were least confident in and needed most support for providing intervention to SWS. Those who needed most support for intervention rated themselves as less knowledgeable about stuttering theory, assessment, and intervention and were less confident about working with students who only stutter and with SWS who have concomitant communication concerns. Greater practitioner confidence in stuttering intervention skills was positively correlated with the number of SWS on caseloads; continuing education credits in stuttering; and knowledge of stuttering theory, assessment, and intervention. Respondents who completed a graduate course on stuttering had greater confidence in stuttering intervention and were less likely to identify a need for support from specialists. Conclusions School speech-language practitioners continue to report needing additional education, practice opportunities, and support, especially with intervention, and desiring specialized guidance to serve SWS. Those with more experience, education, and knowledge about stuttering are more confident and skillful, reflecting the potential positive impact of increased opportunities to learn about and work with SWS. These needs may be addressed through increased availability of specialists in stuttering to consult with school practitioners; opportunities for school-based practitioners to become peer mentors; and provision of readily available, intervention-focused continuing education experiences and resources.

Validity of the Multiple Auditory Processing Assessment-2: A Test of Auditory Processing Disorder.

Purpose A normative study using the Multiple Auditory Processing Assessment-2 (MAPA-2; Schow et al., 2018) was recently completed. With access to these data, the authors extend that work and support a definite construct for auditory processing disorder (APD). The goal here is to examine MAPA-2 reliability and validity (construct, content, and concurrent). Evidence for the APD construct is further buttressed by measures of sensitivity and specificity. Results of MAPA-2 testing on children diagnosed with learning disability (LD), attention-deficit/hyperactivity disorder (ADHD), and specific language impairment (SLI) are included. Method Normative data (previously published as the MAPA-2) allowing derivation of these findings included a representative sample of 748 children (53% girls) ages 7-14 years tested by 54 speech-language pathologists and audiologists in 27 U.S. states. The authors examined diagnostic accuracy based on the American Speech-Language-Hearing Association (2005) criteria (index test) for confirmed cases of APD. The index was also used to identify listening problems for three other diagnostic categories (LD, ADHD, and SLI). Validated questionnaire responses from parents and school personnel allowed incorporation of functional measures widely supported in APD diagnosis but unavailable with other normative and sensitivity/specificity studies. Results Reliability and validity were both satisfactory, and diagnostic accuracy for an APD group of 18 (28% female) compared to the remaining typical group of 625 yielded 89% sensitivity and 82% specificity. The remaining three groups (LD, ADHD, and SLI), where comorbidity was expected to be about 50%, had APD-type listening problems with a prevalence ranging from 52% to 65%. Conclusions Current results provide important evidence for the construct of APD. The MAPA-2 can be administered by an audiologist or speech-language pathologist. A similar diagnostic protocol in Australia yielded positive therapeutic gains. Further study is encouraged to determine if the present positive findings will be found in future research.

Holistic Communication Assessment for Young Children With Cleft Palate Using the International Classification of Functioning, Disability and Health:Children and Youth.

Purpose Children with a cleft palate (± cleft lip; CP±L) can have difficulties communicating and participating in daily life, yet speech-language pathologists typically focus on speech production during routine assessments. The International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY; World Health Organization, 2007) provides a framework for holistic assessment. This tutorial describes holistic assessment of children with CP±L illustrated by data collected from a nonclinical sample of seven 2- to 3-year-old children, 13 parents, and 12 significant others (e.g., educators and grandparents). Method Data were collected during visits to participants' homes and early childhood education and care centers. Assessment tools applicable to domains of the ICF-CY were used to collect and analyze data. Child participants' Body Functions including speech, language, and cognitive development were assessed using screening and standardized assessments. Participants' Body Structures were assessed via oral motor examination, case history questionnaires, and observation. Participants' Activities and Participation as well as Environmental and Personal Factors were examined through case history questionnaires, interviews with significant others, parent report measures, and observations. Results Valuable insights can be gained from undertaking holistic speech-language pathology assessments with children with CP±L. Using multiple tools allowed for triangulation of data and privileging different viewpoints, to better understand the children and their contexts. Several children demonstrated speech error patterns outside of what are considered cleft speech characteristics, which underscores the importance of a broader assessment. Conclusion Speech-language pathologists can consider incorporating evaluation of all components and contextual factors of the ICF-CY when assessing and working with young children with CP±L to inform intervention and management practices.

Voice assessment practices of speech and language therapists in Ireland.

Evidence supports the need for a multiparametric voice assessment incorporating objective and subjective assessment types. European guidelines and the American Speech-Language-Hearing Association recommend a comprehensive voice assessment protocol; however, currently in Ireland, no national standards exist. This study investigates voice assessment practices of speech and language therapists (SLTs) in Ireland, with a particular interest in the use of objective instrumentation. It further elucidates what may act as barriers to the use of instrumental techniques, which has not been addressed in earlier studies. An online questionnaire was distributed to SLTs who work with voice disordered clients, via social media outlets of the Irish Association of Speech and Language Therapy (IASLT) and the Voice Special Interest Group to obtain both qualitative and quantitative data. Forty-five questionnaires were returned; the results of 33 completed questionnaires are presented here. The results suggest that subjective measures (auditory assessment protocols) are more commonly used by SLTs in Ireland than instrumental techniques. Limited access to equipment, the cost of equipment and low prioritization of voice clients in a large caseload were most frequently named as barriers to the use of instrumental assessment. The SLTs acknowledged the need for and expressed interest in more training on the use of instrumental techniques in the assessment of voice disorders. The results provoke discussion surrounding evidence-based practice in voice assessment and have implications for how instrumental techniques are incorporated in the curriculum of SLT training courses and in the continual professional development.

Recommended Protocols for Instrumental Assessment of Voice: American Speech-Language-Hearing Association Expert Panel to Develop a Protocol for Instrumental Assessment of Vocal Function.

Purpose: The aim of this study was to recommend protocols for instrumental assessment of voice production in the areas of laryngeal endoscopic imaging, acoustic analyses, and aerodynamic procedures, which will (a) improve the evidence for voice assessment measures, (b) enable valid comparisons of assessment results within and across clients and facilities, and (c) facilitate the evaluation of treatment efficacy. Method: Existing evidence was combined with expert consensus in areas with a lack of evidence. In addition, a survey of clinicians and a peer review of an initial version of the protocol via VoiceServe and the American Speech-Language-Hearing Association's Special Interest Group 3 (Voice and Voice Disorders) Community were used to create the recommendations for the final protocols. Results: The protocols include recommendations regarding technical specifications for data acquisition, voice and speech tasks, analysis methods, and reporting of results for instrumental evaluation of voice production in the areas of laryngeal endoscopic imaging, acoustics, and aerodynamics. Conclusion: The recommended protocols for instrumental assessment of voice using laryngeal endoscopic imaging, acoustic, and aerodynamic methods will enable clinicians and researchers to collect a uniform set of valid and reliable measures that can be compared across assessments, clients, and facilities.

Factors influencing clinical consistency and variability in voice prosthesis management.

PURPOSE: Anecdotally it is recognised that management of tracheoesophageal speech (TES) post-laryngectomy varies between speech language pathology (SLP) services and clinicians. This study reviewed patterns of practice for TES management to examine patterns of practice and explore factors influencing variability. METHOD: A national survey was completed by SLP's from clinical services which manage TES. This online survey examined demographic and caseload information, initial voice prosthesis (VP) placement and procedures, VP cleaning and care recommendations, humidification management, equipment and service provision, and service delivery options at each site. RESULT: Lead clinicians from 34 sites (85% response rate) responded. Most clinical practice regarding initial VP insertion and management, as well as the timing and delivery of voice rehabilitation was highly consistent. Patient use of antifungal medications, TES and associated equipment provision, humidification management immediately post-surgery and some aspects of initial VP insertion were variable between services. The nature of the clinical setting, equipment funding and level of research evidence influenced variability in practice. CONCLUSION: Variability exists in a number of aspects of practice across Australian services offering TES management. Sources of variability need to be addressed nationally to ensure there is consistent, quality care available for all patients.

Speech pathology as the MasterChef: Getting the right ingredients and stirring the pot.

The purpose of this paper is to consider the many influences that have an impact on appropriate speech-language pathology service delivery. The competitive cooking and entertainment television program, MasterChef, is used as an analogy to consider the ingredients, blend and approach required to improve speech-language pathology services. Speech-language pathologists (SLPs) enter the profession with the aim of assisting those with communication and swallowing disorders to have a better quality of life. Thus, we should be restless to continue to improve our services in order to achieve the best influence and outcomes by changing our recipes and ingredients. However, having good technical skills as a SLP is not sufficient in ensuring that the services are the best they can be. We have to consider available resources, customers and service users, who it is that judges our services, whether we are as good as we could or should be, what can help us improve our services, what the appetite is for our services, and how we incorporate evidence-based practice. This paper considers the value of understanding and using information on incidence and prevalence, evidence-based practice and outcome measurement. Blending technical, clinical and academic abilities with personal skills will result in an award-winning menu.

Assessment practices of Irish speech and language therapists in the evaluation of voice disorders.

It is commonly accepted that the evaluation of voice disorders ought to include extensive perceptual, psychometric, and instrumental measurements. This serves to encapsulate the wide-reaching effects of such a disorder, from the physical impairment in voice production to the psycho-social impact of having a dysphonic voice. In spite of this, no international gold standard exists by which voice disorders should be evaluated, and so speech and language therapists (SLTs) are often tasked with developing an assessment battery for use in their own clinics. The purpose of this study is to determine whether the evaluation of voice disorders by Irish SLTs on a national scale is suitably comprehensive, with particular reference to the guidelines published by the European Laryngological Society. A total of 49 SLTs working in a variety of settings responded anonymously to an electronic survey regarding their assessment practices. Results indicate that therapists are comprehensive in non-instrumental evaluation of voice, but lack both access to and training in instrumental assessment techniques.

Implications of Variability in Clinical Bedside Swallowing Assessment Practices by Speech Language Pathologists.

Speech language pathology (SLP) clinical bedside swallowing assessments (CBSA) are a cornerstone of quality care for patients in acute hospitals who have dysphagia. The CBSA informs clinical diagnosis and decisions regarding further instrumental assessment, and is used to develop a management plan and monitor progress. However, self-report and retrospective research shows that SLPs are highly variable in their use of assessment components considered by experts to be important for quality CBSA, casting doubt on the validity and reliability of CBSA. This prospective study describes the components included by SLPs when designing a standardised evidence based dysphagia assessment protocol for acute care patients and observed patterns of component use. The findings confirm that SLPs use the CBSA for multiple purposes beyond diagnosis of aspiration risk and dysphagia presence/severity. They are highly variable in their use of certain components, but also demonstrate consistent use of a core set. It is apparent that SLPs prioritise the application of clinical reasoning to tailor their CBSA to the patient over following a highly structured item-based protocol. The variability in component use likely reflects a complex clinical reasoning process that draws on a wide variety of information combined with expert knowledge as is also observed in many other medical specialties. Rather than promoting the standardisation of CBSA protocols that constrain SLP practice to strict item-based assessment protocols, consideration should be given to promoting the value and facilitating the clinical reasoning process that supports the utility of the CBSA for diagnosis, patient centred management and treatment planning.

Impact of laryngologist and speech pathologist coassessment on outcomes and billing revenue.

OBJECTIVES/HYPOTHESIS: This study investigated financial and treatment implications of a speech-language pathologist (SLP) performing a voice evaluation at the initial laryngologic visit. STUDY DESIGN: Retrospective chart review. METHODS: Medical records from 75 consecutive adult voice therapy patients during a 3-month period were categorized into two groups: group 1 (n = 37) represented patients who underwent a medical speech evaluation (MSE) at the initial voice assessment with the laryngologist (+SLP), and group 2 (n = 38) represented patients who did not receive an MSE (-SLP). Data collected included age, gender, voice diagnosis, number of therapy sessions attended and cancelled, reason for discharge, and pre- and post-voice therapy Voice Handicap Index-10 (VHI-10) scores. RESULTS: Patients in the +SLP group had fewer cancellations (P = 0.001), greater change in VHI-10 from pre- to post-therapy (P = .001), and were more likely to be discharged from therapy having met therapeutic goals (P = .007) than patients in the -SLP group. In addition, lost revenue over 3 months due to cancellations/no-shows was $2,260 in the +SLP group compared to $7,030 in the -SLP group (P < .001). CONCLUSIONS: Concurrent voice evaluation by an SLP and laryngologist at initial diagnostic visit affects therapy attendance, voice therapy outcomes, and ultimately SLP and departmental billing revenue. Results may be due to more appropriate therapy referrals from SLP assessment of patients in conjunction with a laryngologist. LEVEL OF EVIDENCE: 4.

Monitoring change requires a rethink of assessment practices in voice and speech.

Assessment for the purpose of monitoring change over time requires a different practical and statistical approach to that of assessment for diagnosing impairment. Sophisticated methods exist for identifying strengths and weaknesses in a patient's voice/speech profile, yet our understanding of the impact of repeated assessment is limited. Monitoring change necessitates that stimuli are stable in the absence of any true change in functioning, while remaining sensitive to influences that are considered to alter functioning (degeneration, therapy). The current paper discusses the issues relating to stimuli selection, identifying error within the sample and appropriate statistical models for identifying intra-individual change in the context of clinical and experimental speech or voice examinations.

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.

Validating dynamic assessment of triadic gaze for young children with severe disabilities.

PURPOSE: This research investigated the use of a dynamic assessment (DA) to identify differences among young children with severe disabilities, which would predict progress in learning behaviors indicating coordinated joint attention (CJA). METHOD: Six children 10-24 months of age were enrolled in a 16-week treatment for behaviors indicating CJA, specifically triadic gaze (TG), which is a 3-point gaze shift between object and adult. An initial static assessment documented the children's eligibility for the study and their baseline performance of TG. DA procedures were then implemented to determine each child's performance with examiner support in producing behaviors suggesting joint attention (i.e., tracking, gaze toward an object or an adult, scanning between objects, scanning an object and adult, and TG). RESULTS: Results demonstrated differences among children during the DA via a DA score and a behavioral profile. These results were predictive of differences among children in subsequent learning of TG. CONCLUSION: These data support the validity of DA for describing heterogeneity among young children with severe disabilities who look similar on static assessment but appear differentially ready to learn behaviors associated with joint attention. This knowledge will assist clinicians in planning more efficacious services for young children who struggle to communicate and are at risk for extended therapeutic needs.

The new dining practice standards: speech-language pathologists' guide to their implementation.

In 2010, the "Creating Home II National Symposium on Culture Change and the Food and Dining Requirements" cosponsored by Centers for Medicare and Medicaid services (CMS) and the Pioneer Network created a multidisciplinary task force for dining practice standards. In 2011, this task force crafted and finalized the New Dining Practice Standards. These standards have been agreed upon by 12 national clinical standard setting organizations and will be referred to by CMS as new standards of practice. The new standards include evidence-based research, as well as new thinking in advance of research and corroboration with federal requirements. Speech-language pathologists can guide care communities in implementing the new standards and lead a new era of honoring the person in making informed decisions and mitigating risk of harm at the same time.

A motor speech assessment for children with severe speech disorders: reliability and validity evidence.

PURPOSE: In this article, the authors report reliability and validity evidence for the Dynamic Evaluation of Motor Speech Skill (DEMSS), a new test that uses dynamic assessment to aid in the differential diagnosis of childhood apraxia of speech (CAS). METHOD: Participants were 81 children between 36 and 79 months of age who were referred to the Mayo Clinic for diagnosis of speech sound disorders. Children were given the DEMSS and a standard speech and language test battery as part of routine evaluations. Subsequently, intrajudge, interjudge, and test-retest reliability were evaluated for a subset of participants. Construct validity was explored for all 81 participants through the use of agglomerative cluster analysis, sensitivity measures, and likelihood ratios. RESULTS: The mean percentage of agreement for 171 judgments was 89% for test-retest reliability, 89% for intrajudge reliability, and 91% for interjudge reliability. Agglomerative hierarchical cluster analysis showed that total DEMSS scores largely differentiated clusters of children with CAS vs. mild CAS vs. other speech disorders. Positive and negative likelihood ratios and measures of sensitivity and specificity suggested that the DEMSS does not overdiagnose CAS but sometimes fails to identify children with CAS. CONCLUSIONS: The value of the DEMSS in differential diagnosis of severe speech impairments was supported on the basis of evidence of reliability and validity.

A systematic program of research regarding the assessment of speech-language pathology competencies.

This paper explores the nature and development of competence in speech-language pathology and is informed by the development and validation of a competency-based assessment tool to assess Australian speech-language pathology students' professional performance in the workplace (COMPASS). Background is provided on speech-language pathology competency frameworks in Australia and a systematic program of research to validate this assessment tool. Findings relevant to understanding the nature and development of speech-language pathology competency are described. The domains of competence considered important for practice were found to extend beyond specific processes of professional practice to include generic competencies of reasoning, communication, lifelong learning, and professionalism. The achievement of competency was identified as developmental, and clinical educators were found to validly and reliably identify seven levels of competency development. Competency may transfer across the scope of practice, and marginal students' performances were characterized by a high degree of variability. These findings are discussed in relation to the profession's understanding of competency and speech-language pathology education, professional development, and further research.