Speech and language therapy assessment of patients on the 2-week wait head and neck cancer referral pathway: evidence and opinion following a pilot study.

PURPOSE OF REVIEW: Spiralling numbers of patients are being referred on the two-week wait (2WW) head and neck cancer referral pathway. Only a small proportion are found to have cancer. There is a call for change in the management of these referrals, particularly following coronavirus. Allied health professionals (AHPs) are being encouraged by the NHS to extend their clinical practice to address increased demand. Speech and Language Therapists (SLTs) may offer a solution to some of the 2WW pathway's challenges. RECENT FINDINGS: Recent evidence highlights problems with the pathway and reasons for change. Hoarse voice is consistently found to be the most common presenting symptom. Emerging evidence suggests SLTs can extend their scope of practice to manage new hoarse voice referrals. A pilot project is described. Outcomes from this and other ongoing studies explore efficacy and investment required to make this proposal an achievable prospect for the future. SUMMARY: The management of 2WW referrals on the head and neck cancer pathway needs to change. Preliminary findings suggest SLTs working within the context of the multidisciplinary team can safely extended their role to improve management of these patients. Professional role outline, recognition, guidance, and training framework are needed.

The COVID-19 pandemic and the implementation of telehealth in speech-language and hearing therapy for patients at home: an experience report. / Pandemia do COVID-19 e implementação de telefonoaudiologia para pacientes em domicílio: relato de experiência.

We present an experience report on the implementation of real-time telehealth in speech-language and hearing therapy for patients who were previously seen on an outpatient basis in a primary health care service. The Speech-Language Therapy (SLT) team was monitoring twenty-five users when the first cases of COVID-19 were notified in southern Brazil. Of these, it was judged that twelve patients required at least a monitoring call every two weeks. Teleconsultations were available in this first stage, on an emergency basis, during the implementation of the project in this format. The idea was to guarantee, due to the suspension of the SLT sessions, the maintenance of the care service for patients who could suffer worsening of their cases or even comorbidities. The appointments were carried out by video calls by SLT students, therapists of the extension project, and supervised by a speech-language therapist, synchronously. All conversations and orientations during the teleconsultation were conducted as calmly as possible and, in the case of infant patients, permeated by some playful activities. Telehealth has shown to be an efficient resource for the care of patients with SLT demands, enabling remote care with the same quality as face-to-face care. Besides, it has relevant potential, once there is a significant number of patients, who need SLT assessment and live in regions where there is a shortage of qualified professionals.

Apresentamos um relato de experiência de implementação de telefonoaudiologia em tempo real para pacientes que anteriormente eram atendidos em ambulatório em um serviço de atenção primária em saúde. No total, 25 usuários estavam sendo acompanhados pela equipe de fonoaudiologia quando da notificação dos primeiros casos de COVID-19 no sul do Brasil. Destes, julgou-se que 12 pacientes demandavam teleatendimento, pelo menos, quinzenalmente. A teleconsulta disponibilizada nesta primeira etapa, em caráter emergencial na implementação do projeto neste formato, a fim de garantir a manutenção dos atendimentos de pacientes que poderiam sofrer agravamento ou mesmo comorbidades associadas à suspensão da fonoterapia, foram realizadas por telefone, com vídeo, por estudantes de fonoaudiologia, extensionistas do projeto e supervisionadas por um fonoaudiólogo, de forma síncrona. Todas as conversas e orientações durante a teleconsulta são encaminhadas com a maior calma possível e, no caso de pacientes infantis, permeadas por algumas atividades lúdicas. A telessaúde tem se mostrado um recurso eficiente para atendimento de pacientes com demandas fonoaudiológicas, possibilitando o atendimento remoto com a mesma qualidade que o atendimento presencial. Além disso, tem potencial relevante, considerando que há um número significativo de pacientes que precisam de avaliação fonoaudiológica e residem em regiões nas quais há escassez de profissionais qualificados.

Pandemia do COVID-19 e implementação de telefonoaudiologia para pacientes em domicílio: relato de experiência / The COVID-19 pandemic and the implementation of telehealth in speech-language and hearing therapy for patients at home: an experience report

RESUMO Apresentamos um relato de experiência de implementação de telefonoaudiologia em tempo real para pacientes que anteriormente eram atendidos em ambulatório em um serviço de atenção primária em saúde. No total, 25 usuários estavam sendo acompanhados pela equipe de fonoaudiologia quando da notificação dos primeiros casos de COVID-19 no sul do Brasil. Destes, julgou-se que 12 pacientes demandavam teleatendimento, pelo menos, quinzenalmente. A teleconsulta disponibilizada nesta primeira etapa, em caráter emergencial na implementação do projeto neste formato, a fim de garantir a manutenção dos atendimentos de pacientes que poderiam sofrer agravamento ou mesmo comorbidades associadas à suspensão da fonoterapia, foram realizadas por telefone, com vídeo, por estudantes de fonoaudiologia, extensionistas do projeto e supervisionadas por um fonoaudiólogo, de forma síncrona. Todas as conversas e orientações durante a teleconsulta são encaminhadas com a maior calma possível e, no caso de pacientes infantis, permeadas por algumas atividades lúdicas. A telessaúde tem se mostrado um recurso eficiente para atendimento de pacientes com demandas fonoaudiológicas, possibilitando o atendimento remoto com a mesma qualidade que o atendimento presencial. Além disso, tem potencial relevante, considerando que há um número significativo de pacientes que precisam de avaliação fonoaudiológica e residem em regiões nas quais há escassez de profissionais qualificados.

ABSTRACT We present an experience report on the implementation of real-time telehealth in speech-language and hearing therapy for patients who were previously seen on an outpatient basis in a primary health care service. The Speech-Language Therapy (SLT) team was monitoring twenty-five users when the first cases of COVID-19 were notified in southern Brazil. Of these, it was judged that twelve patients required at least a monitoring call every two weeks. Teleconsultations were available in this first stage, on an emergency basis, during the implementation of the project in this format. The idea was to guarantee, due to the suspension of the SLT sessions, the maintenance of the care service for patients who could suffer worsening of their cases or even comorbidities. The appointments were carried out by video calls by SLT students, therapists of the extension project, and supervised by a speech-language therapist, synchronously. All conversations and orientations during the teleconsultation were conducted as calmly as possible and, in the case of infant patients, permeated by some playful activities. Telehealth has shown to be an efficient resource for the care of patients with SLT demands, enabling remote care with the same quality as face-to-face care. Besides, it has relevant potential, once there is a significant number of patients, who need SLT assessment and live in regions where there is a shortage of qualified professionals.

Impact of school-based allied health therapy via telehealth on children's speech and language, class participation and educational outcomes.

INTRODUCTION: Access to telehealth services for children living in rural and remote areas of Australia is very limited. The delivery of allied health therapies to children in school via telehealth may help reduce inequality and improve academic outcomes over time. METHODS: A service delivering speech and language therapy (SLT) and occupational therapy (OT) via videoconferencing to children at five rural schools was prospectively evaluated. Each child's teacher rated their speech and language, participation in class and educational outcomes at the beginning and end of semester. Change in the summative teacher-rating index over the first and subsequent semesters in which a child received therapy was examined. Independent predictors of change were identified using multivariable linear regression. RESULTS: Over two years, 1029 sessions of SLT and 531 sessions of OT were delivered to 98 children (67% male, 38% in Prep at commencement) via telehealth. In their first semester of therapy, 57 children received SLT, 37 OT and four both therapies. The mean teacher-rating index significantly improved from the beginning (35.05 ± 10.68) to end (40.02 ± 11.75) of the first semester of therapy (p < 0.001). In multivariable linear regression, grade, school and baseline rating were significantly associated with the end-of-semester teacher-rating index. DISCUSSION: Delivering allied health therapy by videoconference may enable children to better engage with schooling. Differences in improvements by grade suggest improvements may be maximised by targeting therapy at certain year levels. This model may be useful in areas with limited access to allied health services.

Speech, Language, and Communication in a Public Health Context: A UK Perspective with Potential Global Application - An Opinion Piece.

Speech and language therapists often contribute to public awareness campaigns as well as supporting, teaching and promoting the facilitation of speech, language, communication, and safe swallowing with the general public and health and social care professionals. These are sometimes considered as public health interventions. It is important to consider the objectives, costs, and impact of this involvement in the same way as reviewing the evidence associated with the more personally targeted interventions with individuals or groups of clients with specific conditions. This opinion piece discusses speech and language therapy in the context of public health, clarifies the terminology, and proposes different approaches to demonstrate its influence associated with its objectives. The content has been informed by a Working Party of the Royal College of Speech and Language Therapists (2017-2018).

Speech and Language Therapy Services for Multilingual Children with Migration Background: A Cross-Sectional Survey in Germany.

Speech, language, and communication needs are particularly common among multilingual and migrant children. More than every third child in Germany has a migrant background. In the city of Bremen, this figure is even higher, including refugee children. The availability of comprehensive data on the provision and uptake of speech and language therapy (SLT) services is still inadequate, especially for multilingual children. However, health-monitoring programs report that migrants differ in many health-related areas from the majority population, mainly in barriers in health care. This study examines the current provision of SLT services for multilingual children following a medical prescription for the specific case of suspected language disorder. Information was obtained from speech-language pathologists (SLPs) representing 28 practices in different districts across one of the moderately largest cities affected by sociospatial polarization. The SLT practices were clustered according to the proportion of minor migrants and minor welfare recipients in the district. The survey included the number and proportion of multilingual children on the SLT caseloads, as well as the age of children by time of referral, physician and SLP diagnoses, application and type of assessment materials, intervention goals, and sociodemographic data of practicing SLPs. Questionnaire responses were analyzed using descriptive statistics and an explanatory interpretive approach. Findings suggest that multilingual children experience later referral compared to monolingual German-speaking children, with approximately half of the multilingual children demonstrating a developmental language disorder (DLD). The SLP's level of experience determines the accuracy of differential diagnosis between communication disorders and typical linguistic variations. Consequently, participation in continuing education focusing on service provision of the multilingual and multicultural clientele is essential. This study highlights the obstacles and the needs for increased multiprofessional awareness and an enhanced professional knowledge to provide effective and swift diagnosis earlier to allow multilingual children with a DLD to access relevant services on equal terms with native resident children.

Early Protocolized Versus Usual Care Rehabilitation for Pediatric Neurocritical Care Patients: A Randomized Controlled Trial.

OBJECTIVE: s: Few feasibility, safety, and efficacy data exist regarding ICU-based rehabilitative services for children. We hypothesized that early protocolized assessment and therapy would be feasible and safe versus usual care in pediatric neurocritical care patients. DESIGN: Randomized controlled trial. SETTING: Three tertiary care PICUs in the United States. PATIENTS: Fifty-eight children between the ages of 3-17 years with new traumatic or nontraumatic brain insult and expected ICU admission greater than 48 hours. INTERVENTIONS: Early protocolized (consultation of physical therapy, occupational therapy, and speech and language therapy within 72 hr ICU admission, n = 26) or usual care (consultation per treating team, n = 32). MEASUREMENTS AND MAIN RESULTS: Primary outcomes were consultation timing, treatment type, and frequency of deferrals and safety events. Secondary outcomes included patient and family functional and quality of life outcomes at 6 months. Comparing early protocolized (n = 26) and usual care groups (n = 32), physical therapy was consulted during the hospital admission in 26 of 26 versus 28 of 32 subjects (p = 0.062) on day 2.4 ± 0.8 versus 7.7 ± 4.8 (p = 0.001); occupational therapy in 26 of 26 versus 23 of 32 (p = 0.003), on day 2.3 ± 0.6 versus 6.9 ± 4.8 (p = 0.001); and speech and language therapy in 26 of 26 versus 17 of 32 (p = 0.011) on day 2.3 ± 0.7 versus 13.0 ± 10.8 (p = 0.026). More children in the early protocolized group had consults and treatments occur in the ICU versus ward for all three services (all p < 0.001). Eleven sessions were discontinued early: nine during physical therapy and two during occupational therapy, none impacting patient outcome. There were no group differences in functional or quality of life outcomes. CONCLUSIONS: A protocol for early personalized rehabilitation by physical therapy, occupational therapy, and speech and language therapy in pediatric neurocritical care patients could be safely implemented and led to more ICU-based treatment sessions, accelerating the temporal profile and changing composition of interventions versus usual care, but not altering the total dose of rehabilitation.

Exploring accounts of collaborative working between speech and language therapists and stroke association communication support coordinators following stroke.

In the United Kingdom, speech and language therapists (SLTs) and Stroke Association communication support coordinators (CSCs) are both employed to provide services for people with communication difficulties following stroke. There is very little literature of this type of collaborative working. This research is unique because it explores collaborative working between SLTs who are employed by the National Health Service and CSCs who are employed by the Stroke Association. Five CSCs and seven SLTs from the East of England participated in a series of in-depth interviews. Data were analysed using thematic analysis informed by an interpretative phenomenological approach. The analysis suggested complex negotiation processes occur at a number of different levels. These levels include negotiation of individual relationships between SLTs and CSCs, negotiating the particular challenges involved in working across organisations and professions, and the need for both roles to negotiate and promote the value of their services at a societal level. The findings of this research are discussed in relation to existing theories and research within the field of collaborative working. Clinical applications are suggested for collaborative working within communication services. We propose that our findings may have relevance to other individuals and organisations delivering services collaboratively.

Communication and well-being outcomes of a hybrid service delivery model of intensive impairment-based treatment for aphasia in the hospital setting: a pilot study.

PURPOSE: This pilot study aimed to evaluate the effects of an intensive hybrid service delivery model (i.e., combining face-to-face individual, computer and group therapy) on communication and well-being for people with aphasia (PWA) in the hospital setting. MATERIALS AND METHODS: The study explored two different intensities of the hybrid model, 4 h/week (Hybrid-4) and 8 h/week (Hybrid-8) both for 8 weeks. Participants ranging from 1 month to 5 years post-onset were allocated using matched-pair randomisation to receive either Hybrid-4 (n = 5) or Hybrid-8 (n = 4) and assessed using a comprehensive language battery by a blinded assessor, as well as selected activity, participation and well-being measures before, immediately after and 4-week post-treatment. RESULTS: All participants in Hybrid-4 and three out of four participants in Hybrid-8 demonstrated clinically significant improvement to measures of language impairment immediately post-treatment, with the majority also demonstrating maintenance effects 4-week post-treatment. Clinically significant improvements to activity, participation and well-being measures were also observed across participants in both groups. CONCLUSIONS: Findings support the potential benefit of employing an intensive hybrid service model and suggest that both 4 and 8 h per week of impairment-based treatment for 8 weeks may result in improvements in communication and well-being for some PWA across different stages of recovery. Implications for rehabilitation The present findings help bridge the gap between what evidence suggests is effective intensity of rehabilitation for aphasia and what can be practically delivered in real-world hospital settings. Findings support the potential clinical value of employing a hybrid service model (using computer, group and individual therapy) to deliver intensive rehabilitation to people with aphasia in the hospital setting, and suggest that clinically significant improvements to communication and well-being can result when the model is delivered at either 4 or 8 h per week. The current study highlights that people with aphasia in the early stages of aphasia recovery can potentially benefit from intensive impairment-based hybrid models of intervention.

The Journey to Interprofessional Collaborative Practice: Are We There Yet?

Interprofessional collaborative practice (IPCP) is a service delivery approach that seeks to improve health care outcomes and the patient experience while simultaneously decreasing health care costs. The current article reviews the core competencies and current trends associated with IPCP, including challenges faced by health care practitioners when working on interprofessional teams. Several conceptual frameworks and empirically supported interventions from the fields of organizational psychology and organization development are presented to assist health care professionals in transitioning their teams to a more interprofessionally collaborative, team-based model of practice.

Parent-implemented home therapy programmes for speech and language: a systematic review.

BACKGROUND: Parent-delivered home programmes are frequently used to remediate speech and language difficulties in young children. However, the evidence base for this service delivery model is limited. AIMS: The aim of this systematic review is to investigate the effectiveness of parent-implemented home programmes in facilitating the development of children's speech and language skills, and to evaluate the cost-effectiveness and feasibility of this service delivery method. METHODS & PROCEDURES: A systematic search of the PsycINFO, CINAHL and ERIC databases was conducted. Quality appraisal of individual studies was conducted. Findings from each of the studies were then integrated to report on outcomes for the child, the parent and the service. OUTCOMES & RESULTS: There is preliminary evidence that home programmes can lead to growth in a child's speech and language skills and are more effective than no intervention, provided the home programmes are used with high dosage rates and direct parent training. CONCLUSIONS & IMPLICATIONS: Home programmes are a potentially useful service delivery model, but caution should be exercised when considering their use to address broader service delivery challenges. Further high-level evidence is needed across all facets of this service delivery model.

The complexities of designing therapy for Maori living with stroke-related communication disorders.

Stroke-related communication disorders can have a substantial impact on Maori whanau (extended family). Timely and appropriate speech-language therapy is required, but there are many challenges in providing this. In this article we discuss the need for a kaupapa Maori approach to speech-language therapy that is designed by Maori for Maori, and undertaken in a Maori way. We report the results of a literature review that revealed a small but significant body of literature describing Maori experiences of stroke, aphasia and speech-language therapy, and evidence that a Maori-specific therapy programme can improve outcomes for people with stroke. We then consider the social and political context that impacts the design and delivery of such an approach. Informed by the literature, we propose a hierarchy of skill and resource acquisition for speech-language therapists, in which they learn why to be culturally safe, how to be culturally safe, and how to interact before creating resources to build relationships, resources for education and for therapy. The creation of a kaupapa Maori speech-language therapy approach should bring together people with stroke, whanau members and service providers to create therapy that crosses sectors and disciplines and acknowledges the wider social and political context.

The speech-language pathologist's role in multidisciplinary burn care: An international perspective.

PURPOSE: To explore international practices of speech-language pathology (SLP) within burn care in order to provide direction for education, training and clinical practice of the burns multidisciplinary team (MDT). METHOD(S): A 17-item online survey was designed by two SLPs experienced in burn care with a range of dichotomous, multiple choice and open-ended response questions investigating the availability and scope of practice for SLPs associated with burn units. The survey was distributed via professional burn association gatekeepers. All quantitative data gathered were analysed using descriptive statistics and qualitative data were analysed using content analysis. RESULT(S): A total of 240 health professionals, from 6 different continents (37 countries) participated within the study. All continents reported access to SLP services. Referral criteria for SLP were largely uniform across continents. The most dominant area of SLP practice was assessment and management of dysphagia, which was conducted in concert with other members of the MDT. CONCLUSION: SLP has an international presence within burn care that is currently still emerging.

Uncovering the theoretical underpinnings of an interprofessional preschool intervention program: Tumbling Together.

BACKGROUND: Intervention programs are rarely tailored for children with self-regulation and communication challenges. Therefore, clinicians develop their own programs as is the case with the preschool program Tumbling Together. This program combines occupational therapy, speech-language therapy, and gymnastics. PURPOSE: The aim of this study was to take an in-depth look at the program to answer the following questions: (a) What are the fundamental concepts of the program? and (b) What is the underlying theoretical model that illustrates the relationships between concepts? METHOD: The qualitative research method of grounded theorizing using situational analysis was employed. FINDINGS: Fourteen main concepts of the program were identified and informed the development of a theoretical model. IMPLICATIONS: A theoretical model incorporating Tumbling Togethers concepts is a first step in evaluating its efficacy. Although the concepts involved are not novel, their unique combination forms a promising intervention approach for this population.

Collaborative working between pediatric speech and language therapy and ENT colleagues: what is good practice?

PURPOSE OF REVIEW: This article considers current evidence pertaining to good practice in joint paediatric speech and language therapy (SLT) and ear, nose and throat (ENT) assessment and management in the general hospital clinic. Because of space limitations, this review excludes those cases that are typically referred into highly specialist clinics dealing with cleft palate or profound hearing loss and cochlear implant. It will instead focus on children with the types of communication difficulties that are related to physical anomalies and conditions impacting on speech, nasal resonance, voice and those cases with a history of fluctuating or mild hearing loss. The value of the multidisciplinary team in appropriate decision making has to be considered in terms of outcomes and related cost-effectiveness. RECENT FINDINGS: Research into the dynamic between paediatric ENT and SLT outcomes remains relatively sparse. Evidence continues to show that multiple factors impact on any decision regarding surgical or SLT interventions. SLT opinion across a range of perceptual, physical and social parameters aids the medical consultation on a case-by-case basis. Current evidence for speech therapy interventions shows that environmental management and family involvement are crucial, and any direct intervention should be well timed and regular to be effective. SUMMARY: The development of communication and listening is easily disrupted because of ENT disease or abnormality. The child's relationship with the ENT consultant and SLT may span several years, and communication difficulties may persist after any apparent physical problem has resolved. It is essential to jointly consider the optimum timing for any surgical and speech interventions so that services are better targeted and cost-effective.

Description of an intensive residential aphasia treatment program: rationale, clinical processes, and outcomes.

PURPOSE: The purpose of this article is to describe the rationale, clinical processes, and outcomes of an intensive comprehensive aphasia program (ICAP). METHOD: Seventy-three community-dwelling adults with aphasia completed a residentially based ICAP. Participants received 5 hr of daily 1:1 evidence-based cognitive-linguistically oriented aphasia therapy, supplemented with weekly socially oriented and therapeutic group activities over a 23-day treatment course. Standardized measures of aphasia severity and communicative functioning were obtained at baseline, program entry, program exit, and follow-up. Results were analyzed using a Bayesian latent growth curve model with 2 factors representing (a) the initial level and (b) change over time, respectively, for each outcome measure. RESULTS: Model parameter estimates showed reliable improvement on all outcome measures between the initial and final assessments. Improvement during the treatment interval was greater than change observed across the baseline interval, and gains were maintained at follow-up on all measures. CONCLUSIONS: The rationale, clinical processes, and outcomes of a residentially based ICAP have been described. ICAPs differ with respect to treatments delivered, dosing parameters, and outcomes measured. Specifying the defining components of complex interventions, establishing their feasibility, and describing their outcomes are necessary to guide the development of controlled clinical trials.

Struggling to be seen and heard: the underserved and unserved populations.

OBJECTIVE: The purpose of this paper is to provide some current information on the topic of the underserved and unserved populations including modern-day slaves, stateless/displaced persons, refugees/migrants and indigenous populations. METHOD: Speech-language pathology education and services for the underserved as well as unserved populations are discussed. Three case studies which demonstrate knowledge transfer and exchange as potential models for future development are presented. CONCLUSION: These case studies lead to more inquiries, studies, innovations and involvement from individuals and groups who are concerned about the underserved and unserved populations.

Language-enriched exercise plus socialization for older adults with dementia: translation to rural communities.

Interventions that stimulate and engage individuals with dementia physically, cognitively, and socially offer promise for improving health and well-being and for potentially slowing functional losses with disease progression. We describe a volunteer-based intervention that combines physical exercise, cognitive-linguistic stimulation, and social outings for older persons living with dementia in rural communities. One-year follow-up data, although clearly preliminary (n = 8), suggest stability in global cognition, mood, and aspects of physical fitness. Challenges to implementing dementia interventions in rural areas are discussed.

Phonological and articulation treatment approaches in Portuguese children with speech and language impairments: a randomized controlled intervention study.

BACKGROUND: In Portugal, the routine clinical practice of speech and language therapists (SLTs) in treating children with all types of speech sound disorder (SSD) continues to be articulation therapy (AT). There is limited use of phonological therapy (PT) or phonological awareness training in Portugal. Additionally, at an international level there is a focus on collecting information on and differentiating between the effectiveness of PT and AT for children with different types of phonologically based SSD, as well as on the role of phonological awareness in remediating SSD. It is important to collect more evidence for the most effective and efficient type of intervention approach for different SSDs and for these data to be collected from diverse linguistic and cultural perspectives. AIMS: To evaluate the effectiveness of a PT and AT approach for treatment of 14 Portuguese children, aged 4.0-6.7 years, with a phonologically based SSD. METHODS & PROCEDURES: The children were randomly assigned to one of the two treatment approaches (seven children in each group). All children were treated by the same SLT, blind to the aims of the study, over three blocks of a total of 25 weekly sessions of intervention. Outcome measures of phonological ability (percentage of consonants correct (PCC), percentage occurrence of different phonological processes and phonetic inventory) were taken before and after intervention. A qualitative assessment of intervention effectiveness from the perspective of the parents of participants was included. OUTCOMES & RESULTS: Both treatments were effective in improving the participants' speech, with the children receiving PT showing a more significant improvement in PCC score than those receiving the AT. Children in the PT group also showed greater generalization to untreated words than those receiving AT. Parents reported both intervention approaches to be as effective in improving their children's speech. CONCLUSIONS & IMPLICATIONS: The PT (combination of expressive phonological tasks, phonological awareness, listening and discrimination activities) proved to be an effective integrated method of improving phonological SSD in children. These findings provide some evidence for Portuguese SLTs to employ PT with children with phonologically based SSD.

Parent-implemented enhanced milieu teaching with preschool children who have intellectual disabilities.

PURPOSE: The purpose of this study was to compare the effects of enhanced milieu teaching (EMT) implemented by parents and therapists versus therapists only on the language skills of preschool children with intellectual disabilities (IDs), including children with Down syndrome and children with autism spectrum disorders. METHOD: Seventy-seven children were randomly assigned to 2 treatments (parent + therapist EMT or therapist-only EMT) and received 36 intervention sessions. Children were assessed before, immediately after, 6 months after, and 12 months after intervention. Separate linear regressions were conducted for each standardized and observational measure at each time point. RESULTS: Parents in the parent + therapist group demonstrated greater use of EMT strategies at home than untrained parents in the therapist-only group, and these effects maintained over time. Effect sizes for observational measures ranged from d = 0.10 to d = 1.32 favoring the parent + therapist group, with the largest effect sizes found 12 months after intervention. CONCLUSION: Findings from this study indicate generally that there are benefits to training parents to implement naturalistic language intervention strategies with preschool children who have ID and significant language impairments.