Who gets help for pre-school communication problems? Data from a prospective community study.

OBJECTIVE: Pre-school communication problems are common, with implications for school readiness and educational achievement. Help is available from a variety of community healthcare providers. This study examined the extent to which help is received, and the predictors of service receipt. DESIGN AND SETTING: Prospective community study, in Melbourne, Victoria. PARTICIPANTS AND METHOD: At age 4 years, we assessed the speech, receptive and expressive language and fluency of 1607 children and gave feedback to their parents. At age 5 years, 983 families provided data on service use for communication problems between and 4 and 5 years. We compared service use between participants with and without impairment, and used logistic regression to estimate the strength of association between potential predictors (gender, socio-economic status, maternal education, English-speaking background status, family history of speech and language problems and parent concern) and service use (binary outcome). RESULTS: Data were available for both communication status and service use for 753 children. Only 44.9% of the 196 children with communication impairment received help from a professional. Furthermore, 7% of the 557 that did not meet criteria for communication impairment nevertheless received help from a professional. Parent concern was the strongest predictor of service use (adjusted odds ratio = 9.0; 95% CI: 5.6-14.8). CONCLUSIONS: Both over- and under-servicing for communication problems were evident. This study shows that accessing help for communication problems requires more than simply informing parents about the problem and having services available; there is a need for systematic support to get the right children to services.

Profiles of language development in pre-school children: a longitudinal latent class analysis of data from the Early Language in Victoria Study.

BACKGROUND: Pre-school language impairment is common and greatly reduces educational performance. Population attempts to identify children who would benefit from appropriately timed intervention might be improved by greater knowledge about the typical profiles of language development. Specifically, this could be used to help with the early identification of children who will be impaired on school entry. METHODS: This study applied longitudinal latent class analysis to assessments at 8, 12, 24, 36 and 48 months on 1113 children from a population-based study, in order to identify classes exhibiting distinct communicative developmental profiles. RESULTS: Five substantive classes were identified: Typical, i.e. development in the typical range at each age; Precocious (late), i.e. typical development in infancy followed by high probabilities of precocity from 24 months onwards; Impaired (early), i.e. high probabilities of impairment up to 12 months followed by typical language development thereafter; Impaired (late), i.e. typical development in infancy but impairment from 24 months onwards; Precocious (early), i.e. high probabilities of precocity in early life followed by typical language by 48 months. The entropy statistic (0.84) suggested classes were fairly well defined, although there was a non-trivial degree of uncertainty in classification of children. That half of the Impaired (late) class was expected to have typical language at 4 years and 6% of the numerically large Typical class was expected to be impaired at 4 years illustrates this. Characteristics indicative of social advantage were more commonly found in the classes with improving profiles. CONCLUSIONS: Developmental profiles show that some pre-schoolers' language is characterized by periods of accelerated development, slow development and catch-up growth. Given the uncertainty in classifying children into these profiles, use of this knowledge for identifying children who will be impaired on school entry is not straightforward. The findings do, however, indicate greater need for language enrichment programmes among disadvantaged children.

Predictors of parents seeking help or advice about children's communication development in the early years.

BACKGROUND: Children's access to services for communication disorders is often determined by parental decisions to seek help or advice. The factors that predict whether parents seek help/advice about their child's communication development were explored in this study. METHODS: Parents of children in a large, community cohort of children (the Early Language in Victoria Study) were asked whether they had sought help or advice about speech and language development at 1, 2, 3 and 4 years. Child, family and environmental variables, as well as parental concern and children's communication status, were used to predict help/advice seeking. The communication abilities of those in the help-seeking group were also evaluated. RESULTS: Gender, age, children's communication status and parental concern were consistent predictors of help/advice seeking. Significant over and under-identification was evident, and there was preliminary evidence that children with overt communication difficulties (such as unintelligible speech) were more likely to receive help. CONCLUSIONS: Parental support and education, as well as education of professionals who regularly have contact with young children, is necessary to support appropriate early identification of communication problems. Further research into service level factors such as availability and accessibility which may support or inhibit help/advice seeking is also indicated.

Grounded theory as a method for research in speech and language therapy.

BACKGROUND: The use of qualitative methodologies in speech and language therapy has grown over the past two decades, and there is now a body of literature, both generally describing qualitative research, and detailing its applicability to health practice(s). However, there has been only limited profession-specific discussion of qualitative methodologies and their potential application to speech and language therapy. AIM: To describe the methodology of grounded theory, and to explain how it might usefully be applied to areas of speech and language research where theoretical frameworks or models are lacking. METHODS & PROCEDURES: Grounded theory as a methodology for inductive theory-building from qualitative data is explained and discussed. Some differences between 'modes' of grounded theory are clarified and areas of controversy within the literature are highlighted. The past application of grounded theory to speech and language therapy, and its potential for informing research and clinical practice, are examined. MAIN CONTRIBUTION: This paper provides an in-depth critique of a qualitative research methodology, including an overview of the main difference between two major 'modes'. The article supports the application of a theory-building approach in the profession, which is sometimes complex to learn and apply, but worthwhile in its results. CONCLUSIONS: Grounded theory as a methodology has much to offer speech and language therapists and researchers. Although the majority of research and discussion around this methodology has rested within sociology and nursing, grounded theory can be applied by researchers in any field, including speech and language therapists. The benefit of the grounded theory method to researchers and practitioners lies in its application to social processes and human interactions. The resulting theory may support further research in the speech and language therapy profession.

Exploring the implementation and use of outcome measurement in practice: a qualitative study.

BACKGROUND: Outcome measurement is important to clinical practice--yet outcome many speech and language therapists find it difficult to apply measures in practice, and not all clinicians and services have been able to implement and/ or use outcome measurement successfully. To date there has been little research to explain why implementation is often unsuccessful, and to provide clinicians and managers with direction as to the likely barriers and facilitators which should be considered. AIMS: To develop a theoretical framework to explain the implementation and use of outcome measurement in clinical practice by speech and language therapists. METHODS & PROCEDURES: A qualitative, inductive theory-building approach, using grounded theory methodology, was applied. This included theoretical sampling, constant comparison, memo writing, and theoretical integration. Participants were 16 Australian managers and clinicians who were using, or who had used, outcome measures. OUTCOMES & RESULTS: The resulting theoretical framework explains two interactive stages that occur when speech pathologists attempt to use outcome measurements in practice. First, clinicians must 'try on' outcome measurement in their own context, examining the way it fits with existing areas, such as their normal practices and priorities, and the wider group and organizational context. Having identified where outcome measurement does not 'fit', clinicians attempt to 'align' outcome measurement with the context (or vice versa), in order to create a better fit between the two. Strategies of 'tailoring' outcome measurement (e.g. using only parts of a measure) or 'accommodating' outcome measurement (e.g. changing routines to allow time for outcome measurement ratings) are possible, but are dependent on clinicians having a true picture of outcome measurement, the role and need for the data, and the existing context. Clinicians must also have control over the areas that need to change in order for outcome measurement and the context to 'align'. Where outcome measurement and the context can be aligned, outcome measures are more easily used. CONCLUSIONS: The theory provides a framework for considering the use of outcome measurement in clinical practice. Implications for implementing outcome measurement in clinical practice are discussed, including the need to clarify the role and need for the data; the requirement that clinicians understand how outcome measurement fits with context outside of their own personal purview; and the need for managers to support change to areas that are outside of the control of clinicians.