'We are in this together' voices of speech-language pathologists working in South African healthcare contexts during level 4 and level 5 lockdown of COVID-19.

BACKGROUND: SARS-CoV-2 (COVID-19) has had a significant impact on every South African but more specifically healthcare professionals, including speech-language pathologists (SLPs). In response to the COVID-19 pandemic, South Africa implemented a nationwide lockdown as confirmed cases continued to rise. Understanding the impact of COVID-19 on SLPs has a three-fold purpose: to re-evaluate service provision, service delivery platforms and to identify the need for support to SLPs during a time of crisis. It is also crucial in guiding how policies and interventions need to be modified. OBJECTIVES: The study aimed to better understand how the workspace of SLPs in hospitals was impacted by COVID-19, how they experienced this process and the implications for them as healthcare professionals in both the private and public sector throughout South Africa. METHODOLOGY: An exploratory cross-sectional study design was used to meet the aims of the study. Thirty-nine SLPs from different provinces in South Africa, working in government and private hospitals during COVID-19, responded to the online survey. Results were analysed using descriptive statistics and thematic content analysis. RESULTS: SLPs' roles, responsibilities and service delivery were impacted by COVID-19. It was necessary for typical outpatient therapy services to be modified; there were changes to the role of the SLP in the hospital and inpatient services were curtailed. CONCLUSION: This study provides insightful information to SLPs employed in hospitals to know that they are experiencing similar challenges. It also confirms the resilience of healthcare professionals, including SLPs, when faced with novel and unprecedented situations.

Children With Cortical Visual Impairment and Complex Communication Needs: Identifying Gaps Between Needs and Current Practice.

Purpose This scoping study sought to establish a baseline for how well the needs of children with cortical visual impairment (CVI) who use augmentative and alternative communication (AAC) are currently aligned with the services available to them. CVI is the most common cause of visual impairment in children today, and AAC methods rely heavily on vision. Yet, the prevalence of CVI in children who use AAC methods is not yet known, and there is virtually no research concerning use of AAC with children with CVI. Our overarching goals were to identify barriers and suggest priorities for improving outcomes for these children. Method Surveys were distributed anonymously online to professionals from multiple disciplines in different school-based settings and to parents of children with CVI who use AAC. Results School-based professionals identified many barriers, including a lack of knowledge and skills about CVI and about AAC, limited access to training and experts, and concerns about services being delivered in isolated silos with limited time allotted for interprofessional collaboration and planning. Parent reported that their children (M age = 11 years) continued to rely predominantly on body-based forms of communication and lacked access to symbolic language, which, in AAC, is primarily visually based. Conclusions The barriers to services identified by school-based professionals indicate a need to develop and disseminate reliable information about CVI and AAC, both at a preservice and in-service level and, while doing so, to respect the diversity of stakeholders who need this information, including parents. Future research on what types of AAC approaches support the development of language and communication skills for children with CVI is essential.

Community-Based Hearing and Vision Screening in Schools in Low-Income Communities Using Mobile Health Technologies.

Introduction Globally, more than 50 million children have hearing or vision loss. Most of these sensory losses are identified late due to a lack of systematic screening, making treatment and rehabilitation less effective. Mobile health (mHealth), which is the use of smartphones or wireless devices in health care, can improve access to screening services. mHealth technologies allow lay health workers (LHWs) to provide hearing and vision screening in communities. Purpose The aim of the study was to evaluate a hearing and vision school screening program facilitated by LHWs using smartphone applications in a low-income community in South Africa. Method Three LHWs were trained to provide dual sensory screening using smartphone-based applications. The hearScreen app with calibrated headphones was used to conduct screening audiometry, and the Peek Acuity app was used for visual acuity screening. Schools were selected from low-income communities (Gauteng, South Africa), and children aged between 4 and 9 years received hearing and vision screening. Screening outcomes, associated variables, and program costs were evaluated. Results A total of 4,888 and 4,933 participants received hearing and vision screening, respectively. Overall, 1.6% of participants failed the hearing screening, and 3.6% failed visual acuity screening. Logistic regression showed that female participants were more likely to pass hearing screening (OR = 1.61, 95% CI [1.11, 2.54]), while older children were less likely to pass visual acuity screening (OR = 0.87, 95% CI [0.79, 0.96]). A third (32.5%) of referred cases followed up for air-conduction threshold audiometry, and one in four (25.1%) followed up for diagnostic vision testing. A high proportion of these cases were confirmed to have hearing (73.1%, 19/26) or vision loss (57.8%, 26/45). Conclusions mHealth technologies can enable LHWs to identify school-age children with hearing and/or vision loss in low-income communities. This approach allows for low-cost, scalable models for early detection of sensory losses that can affect academic performance.

The Implementation of Telepractice in Speech Language Pathology in Hong Kong During the COVID-19 Pandemic.

Introduction: The aim of this study was to investigate the accelerated emergence of telepractice in speech language pathology during the coronavirus disease 2019 (COVID-19) pandemic in Hong Kong-a small city with limited accessibility concern that telepractice has not been widely implemented. Method: An online survey of speech therapists in Hong Kong was conducted between February and March in 2020. The survey comprised up to 15 questions to assess participants' demographics, existing service delivery in telepractice, perception, and their training and knowledge on telepractice. Results: One hundred thirty-five speech (n = 135) speech language pathologists responded to the survey. About one-third (34.8%; n = 47) of participants reported having provided services through telepractice, whereas 72.3% of them started in <3 months and half of them considered it was less effective than face-to-face service. Among the other participants (n = 88), 83% of them indicated that unsuitable patient type and age as the main reason for not providing telepractice. The majority of participants had no prior training for delivering telepractice, and focused on technology when asked about their desired training. Knowledge of participants on telepractice was found only to align fairly with international guidelines. Discussions: The survey findings suggested that telepractice provision in Hong Kong was different from that of other countries where telepractice has been well established, due to the accelerated emergence by the COVID-19 pandemic. Conclusions: The study showed how the development of telepractice would be like in a short time frame, and findings on perception and desired training could be a reference for a better establishment of this model of service.

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.

School-Based Speech-Language Pathologists' Perceived Self-Efficacy in Conducting Multidimensional Treatment With Children Who Stutter.

Purpose The purposes of this study were to examine the self-efficacy of school-based speech-language pathologists (SLPs) in conducting multidimensional treatment with children who stutter (CWS) and to identify correlates of self-efficacy in treating speech-related, social, emotional, and cognitive domains of stuttering. Method Three hundred twenty randomly selected school-based SLPs across the United States responded to an online survey that contained self-efficacy scales related to speech, social, emotional, and cognitive components of stuttering. These ratings were analyzed in relation to participants' beliefs about stuttering treatment and their comfort level in treating CWS, perceived success in therapy, and empathy levels, in addition to their academic and clinical training in fluency disorders as well as demographic information. Results Overall, SLPs reported moderate levels of self-efficacy on each self-efficacy scale and on a measure of total self-efficacy. Significant positive associations were observed between SLPs' self-efficacy perceptions and their comfort level in treating CWS, self-reported success in treatment, beliefs about the importance of multidimensional treatment, and self-reported empathy. There were some discrepancies between what SLPs believed was important to address in stuttering therapy and how they measured success in therapy. Conclusions Among school-based SLPs, self-efficacy for treating school-age CWS with a multidimensional approach appears stronger than previously reported; however, more progress in training and experience is needed for SLPs to feel highly self-efficacious in these areas. Continuing to improve clinician self-efficacy for stuttering treatment through improved academic training and increased clinical experiences should remain a high priority in order to enhance outcomes for CWS. Supplemental Material https://doi.org/10.23641/asha.12978194.

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.

Speech-Language Pathology Services in the Schools: A Follow-Up 9 Years Later.

Purpose Speech-language pathologists (SLPs) in the schools provide services to students with a variety of disorders and severity levels. This study built upon a previously published survey (Brandel & Loeb, 2011) to examine whether factors related to the place and time for services for students with language disorders had changed since the 2008 survey and to examine the differentiation of decisions made by the SLPs across the three severity levels. Method Responses from 439 SLPs to an online national survey related to the place and time of services for students with language disorders were examined using regression in regard to the current factors impacting service delivery and the amount of variation in these decisions by the individual SLPs across the three severity levels. Results Similar to previous findings, students participated in services primarily in groups outside the classroom once or twice a week for 20-30 min. Factors that continued to impact decisions were the SLP's caseload and year of graduation. Related to the differentiation of decisions, most SLPs made two different decisions across the three severity levels for where and how long to provide services, while almost one third made the same decision for the place. Conclusions The results indicate that service delivery and the factors impacting it have remained relatively the same. While most SLPs do differentiate decisions related to time, less variation is observed regarding the place for services. Research is needed to clearly identify barriers and test possible solutions so that school practice can improve.

Speech-Language Pathology Management for Adults With COVID-19 in the Acute Hospital Setting: Initial Recommendations to Guide Clinical Practice.

Purpose This document outlines initial recommendations for speech-language pathology management of adult patients with COVID-19 in the acute hospital setting. Method The authors initially developed these recommendations by adapting those developed for physical therapists working with patients with COVID-19 by Thomas et al. (2020). The recommendations then underwent review by 14 speech-language pathologists and rehabilitation-focused academics representing seven countries (Belgium, Brazil, Canada, Ireland, Japan, New Zealand, the United States). The authors consolidated and reviewed the feedback in order to decide what should be included or modified. Applicability to a global audience was intended throughout the document. Results The authors had 100% agreement on the elements of the recommendations that needed to be changed/modified or added. The final document includes recommendations for speech-language pathology workforce planning and preparation, caseload management, service delivery and documentation, as well as recommendations for the selection of appropriate personal protective equipment and augmentative and alternative communication equipment in the acute care hospital setting. Conclusions Speech-language pathologists play a critical role in the assessment, management, and treatment of patients with COVID-19. Several important considerations need to be made in order to meet the needs of this unique patient population. As more is learned about the impact of the virus on swallowing and communication, the role of the speech-language pathologist on interdisciplinary care teams will remain paramount.

Morphological Knowledge: Opportunities for Collaboration Through Multitiered System of Supports.

Purpose The study of morphological knowledge and its role in literacy development for early elementary students is growing. The aim of this tutorial is to illustrate the role a school-based speech-language pathologist (SLP) has as a collaborative partner in multitiered system of supports (MTSS) in elementary for morphological knowledge. Method This tutorial presents the role of morphology in the English writing system and the documented benefit of morphological interventions to support students' oral and written language development. Next, the role of morphology in literacy development as it appears in curricular standards is highlighted. Lastly, strategies are provided for how SLPs can be part of a collaborative educational team to increase morphological knowledge in early elementary school within an MTSS framework. Conclusion Given school-based SLPs' language and literacy expertise, we are well suited for engaging in collaborative partnerships in the school setting to increase academic outcomes. The information presented in this tutorial provides a guide to establish collaborative partnerships within educational teams to support morphological knowledge development through all MTSS tiers. Additionally, the need for further evidence to support the role of morphological knowledge in literacy development is presented.

Look at Mummy: challenges in training parents to deliver a home treatment program for childhood apraxia of speech in a rural Canadian community.

INTRODUCTION: Children requiring speech pathology services in rural and remote locations face many barriers in accessing adequate services. This has particular consequences for children who need intensive treatment for therapy to be effective, such those with childhood apraxia of speech (CAS). Parent training has been used to overcome speech pathology service delivery barriers for a range of other communication disorders. However, the effectiveness of training parents to deliver a motor-based treatment for CAS within rural and remote contexts has not been evaluated. This study examined the effectiveness and feasibility of training parents in a rural community to use the treatment approach of dynamic temporal and tactile cueing (DTTC) in order to provide more intensive treatment sessions at home. METHODS: The study used an experimental single case across behaviours design and parent interviews to evaluate outcomes both quantitatively and qualitatively. The study included four parent-child dyads from a mixed socioeconomic rural community in Canada. Child participants ranged in age from 3 years to 8 years. Child treatment outcomes were measured using an improvement rate difference (IRD) calculation based on percentage of phonemes correct. Fidelity to the treatment protocol was measured using a fidelity score. RESULTS: All parents reported challenges in carrying out the program due to social and behavioural challenges. Parents also reported benefits such as being able to spend more time with their child and learning some useful cueing techniques. Only one of the four participants had a moderate effect size for his target words (IRD=57%). CONCLUSION: While training parents to deliver DTTC may be effective for some parent-child dyads, clinicians are advised that parent training may not be suitable for all families, and parents in rural and remote communities may face particular social circumstances that make following through with an intensive treatment program difficult.

Delegation models in dysphagia management: Current policy, clinical perceptions and practice patterns.

Purpose: Delegation to Allied Health Assistants (AHAs) is an effective workforce solution in a number of areas of adult speech-language pathology (SLP) practice. However, reports of AHA delegation in the area of dysphagia management are limited. The aim of this study was to synthesise information from policy documents and current clinical practice to examine the nature of AHA delegation in dysphagia management.Method: A mixed method design involving a document review of 13 policy documents on AHA delegation, and a survey of 44 SLP managers regarding current delegation models.Result: Policy and current practice were largely congruent. Despite policy support for AHA delegation, 77% reported using delegation models but only 26% used them fairly often/very often in dysphagia management. Both policy and survey findings support AHA training prior to task delegation, however, the nature of training was unspecified. Good governance is integral to successful delegation and managers recognised the need to increase standardisation of AHA capability assessment.Conclusion: AHA delegation in dysphagia management is supported by policy and is being implemented in clinical services. However further work detailing governance and training requirements is needed, as well as systematic evaluation of the safety and benefits of these models.

Implementation of speech pathology telepractice services for clinical swallowing assessment: An evaluation of service outcomes, costs and consumer satisfaction.

INTRODUCTION: Timely assessment of swallowing disorders (dysphagia) by speech pathologists helps minimise patient risk, optimise quality of life, and limit healthcare costs. This study involved a multi-site implementation of a validated model for conducting adult clinical swallowing assessments via telepractice and examined its service outcomes, costs and consumer satisfaction. METHODS: Five hub-spoke telepractice services, encompassing 18 facilities were established across a public health service. Service implementation support, including training of the telepractice speech pathologists (T-SP) and healthcare support workers in each site, was facilitated by an experienced project officer. New referrals from spoke sites were managed by the hub T-SP as per published protocols for dysphagia assessments via telepractice. Data was collected on existing service models prior to implementation, and then patient demographics, referral information, session outcomes, costs and patient and T-SP satisfaction when using telepractice. RESULTS: The first 50 sessions were analysed. Referrals were predominantly for inpatients at spoke sites. Telepractice assessments were completed successfully, with only minor technical issues. Changes to patient management (i.e. food/fluid changes post assessment) to optimise safety or progress oral intake, was required for 64% of patients. Service and cost efficiencies were achieved with an average 2-day reduction in waiting time and an average cost benefit of $218 per session when using the telepractice service over standard care. High clinician and patient satisfaction was reported. CONCLUSION: Telepractice services were successfully introduced across multiple sites, and achieved service and cost benefits with high consumer satisfaction.

'It depends': Characterizing speech and language therapy for preschool children with developmental speech and language disorders.

BACKGROUND: Several studies have suggested that practitioners hold speech and language therapy (SLT) practice as tacit and consequently it is difficult for the therapist to describe. The current study uses a range of knowledge elicitation (KE) approaches, a technique not used before in SLT, as a way of accessing this tacit knowledge. There is currently no agreed framework that establishes key factors underpinning practice for preschool children with speech and language disorders. This paper attempts to address that gap. AIMS: To develop a framework of SLTs' practice when working with preschool children with developmental speech and language disorders (DS&LD). METHODS & PROCEDURES: A mixed-methods approach was adopted for this study. Data were collected iteratively, from 245 SLTs with experience of working with preschool children with DS&LD across sites in England, by means of focus groups and national events. There were three stages of data collection: local sites, specific-interest groups and two national events. KE techniques were used to gather data, with initial data being collected in local site focus groups. Findings from groups were taken to subsequent larger groups where a combination of concept mapping, teach-back and sorting exercises generated a more detailed description of practice, using discussion of consensus and disagreement to stimulate further exploration and definition and provide validatory evidence. OUTCOMES & RESULTS: This paper provides a high-level framework of therapy for preschool children with DS&LD that makes practice explicit in this area. The framework proposes that therapists' aims for this group of children fall into three categories: addressing children's areas of impairment and skills; achieving functionally meaningful skills and carryover; and supporting adults to provide a supportive communication environment. The exact configuration is shaped by the child's context and needs. CONCLUSIONS & IMPLICATIONS: The framework highlights themes that are well researched in the literature (e.g., speech) and others that have been little studied (e.g., adult understanding), indicating a disconnect between research evidence and practice. The research also highlights the complex nature of interventions for preschool children with DS&LD and the importance therapists attribute to tailoring therapy to individual needs. The framework provides a scaffold upon which SLTs can focus their clinical practice and encourages the profession to understand and explore better the gaps between research evidence and clinical practice for preschool children with DS&LD.

Dysphagia care for adults in the community setting commands a different approach: perspectives of speech-language therapists.

BACKGROUND: Descriptions of community-based speech-language therapy (SLT) dysphagia practices and services are underrepresented in the research literature, despite the prevalence of dysphagia in the community. Owing to a globally ageing population and government drives to support people to remain living at home rather than in hospital or aged care, there is a growing need for SLT services to be responsive to the needs of clients living at home in the community, referred to in this study as 'community-based clients'. Exploration of current SLT services and dysphagia care practices for this population may identify ways services can be designed and enhanced to better meet the needs of clients and carers. AIMS: To explore the nature (i.e., characteristics) of dysphagia services and SLT clinical practices for adults with dysphagia living at home in the community. METHODS & PROCEDURES: Using a qualitative descriptive approach positioned within an explanatory sequential mixed methods design, this study explored SLT services and practices for adults with dysphagia living in the community to explain further and elaborate on findings from an earlier quantitative study. A total of 15 SLTs working with community-based clients with dysphagia were recruited using purposive representative sampling. Content analysis was used to explore the data. OUTCOMES & RESULTS: The overarching theme of community commands a different approach and was illustrated by three subthemes that highlighted how and why a different approach to dysphagia care in the community setting was necessary: (1) skills and mindset require adaptation in the community context; (2) values and approaches are different in the community context; and (3) organizational influences impact service delivery in the community context. From the data, it is apparent that the work undertaken in the community setting differs from dysphagia care in other settings and requires adapted SLT skills, values and approaches that encompass holistic care, client autonomy and carer engagement. SLT practices are also informed by organizational influences such as policies and resourcing, which in some services were enablers, while for others these presented challenges. CONCLUSIONS & IMPLICATIONS: Community-based SLT services must continue to foster flexible, responsive practices by SLTs to ensure the needs of clients and carers are met now and in future.

Speech and language therapy for primary progressive aphasia across the UK: A survey of current practice.

BACKGROUND: Primary progressive aphasia (PPA) describes a heterogeneous group of language-led dementias. People with this type of dementia are increasingly being referred to speech and language therapy (SLT) services. Yet, there is a paucity of research evidence focusing on PPA interventions and little is known about SLT practice in terms of assessment and provision of intervention. AIMS: To survey the practices of SLTs in the areas of assessment and intervention for people with PPA. METHODS & PROCEDURES: A 37-item, pilot-tested survey was distributed electronically through the Royal College of Speech and Language Therapists (RCSLT), Clinical Excellence Networks (CENs) and social media networks. Survey items included questions on care pathways, assessment and intervention approaches, and future planning. Analysis was conducted using descriptive statistics and thematic analysis. OUTCOMES & RESULTS: A total of 105 SLTs completed the survey. Respondents reported more frequently using formal assessment tools designed for stroke-related aphasia than for dementia. Informal interviews were reportedly always used during assessment by almost 80% of respondents. Respondents were significantly more likely to use communication partner training than impairment-focused interventions. Goal attainment was the most commonly used outcome measure. Respondents provided 88 goal examples, which fell into six themes: communication aid; conversation; functional communication; impairment focused; specific strategy; and communication partner. Additionally, respondents reported addressing areas such as future deterioration in communication and cognition, decision-making and mental capacity, and driving. Ten (9.4%) respondents reported the existence of a care pathway for people with PPA within their service. CONCLUSIONS & IMPLICATIONS: This survey highlights the range of current PPA assessment and intervention practices in use by the respondents. Communication partner training is commonly used by the surveyed SLTs, despite the lack of research evidence examining its effectiveness for PPA. There is a need to develop evidence-based care pathways for people with PPA in order to advocate for further commissioning of clinical services.

A National Survey of Speech-Language Pathologists' Engagement in Interprofessional Collaborative Practice in Schools: Identifying Predictive Factors and Barriers to Implementation.

Purpose This study examined the models of collaboration used by school-based speech-language pathologists (SLPs) during the provision of special education services including factors predicting use of the interprofessional collaborative practice (IPP) model and barriers to collaboration. Method School-based SLPs responded to a survey on models of collaboration within their work setting. Anchored vignettes were created to determine their engagement in 3 different models (i.e., multidisciplinary, interdisciplinary, and interprofessional) used in the provision of special education services during evaluation and intervention. Predictive factors supporting and/or hindering the use of IPP were identified. Results Results demonstrated low percentages of school-based SLPs engaging in IPP during initial evaluations (8%), eligibility meetings (43%), and intervention sessions (14%). Three factors predicted use of IPP in schools: prior training in collaboration, years of experience, and educational setting. The most frequently cited barriers to SLPs' engagement in collaboration included time constraints/scheduling (48%), resistance from other professionals (23%), and lack of support from employers/administration (11%). Conclusions The results of the current study indicated that systemic change is needed at both the university and public school levels. At the university level, preprofessional students need collaborative learning opportunities that are integrated across programs and colleges. School-based SLPs and other education professionals could benefit from job-embedded learning focused on IPP to increase their knowledge and engagement in IPP and improve student outcomes. Supplemental Material https://doi.org/10.23641/asha.9340760.

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.

Evaluation of a community of practice for speech-language pathologists in aphasia rehabilitation: a logic analysis.

BACKGROUND: Aphasia is a communication disorder affecting participation. Although there are evidence-based practice recommendations about participation and aphasia rehabilitation, it may be challenging for speech-language pathologists to ensure that rehabilitation activities have an impact on the person's participation, in part due to time limitations. Participation remains limited after rehabilitation for persons who have aphasia. Communities of practice (CoPs) are a collaborative knowledge transfer strategy that can be used for evidence-based practice implementation. The aim of this study was to describe the components and evaluate a CoP for speech-language pathologists about participation and aphasia rehabilitation. METHODS: Logic analysis was used to determine the adequacy between resources, implemented activities, outputs and short-term outcomes of the CoP. Qualitative and quantitative descriptive data were collected through observation and participants' logbooks. Outputs and outcomes of the CoP were revealed through thematic analysis and interpretation of descriptive statistics. RESULTS: Resources including CoP design and educational aims, human and material resources were combined to create various web-based, online and offline activities. Participants invested more time per week than expected in the CoP, shared and created clinical tools and appreciated the array of suggested activities. Participant engagement allowed them to reflect, interact and collaborate with each other. All 13 participants reported they acquired knowledge about clinical tools and 12 mentioned they reflected on their practice. While the CoP was ongoing, six participants noticed evidence-practice gaps, seven prepared to change their practice, and three changed their practice towards including more participation-based considerations. CONCLUSIONS: This study showed that speech-language pathologists can include more participation-based approaches in aphasia rehabilitation as a result of participating in a time-bound, web-based CoP.

Does Efficacy Equal Lasting Impact? A Study of Intervention Short Term Gains, Impact on Diagnostic Status, and Association with Background Variables.

OBJECTIVE: This article examines the efficacy of language intervention services for monolingual and immigrant children in a public clinic in Montreal, Canada. Intervention is provided in French for a preset number of sessions regardless of intervention needs. The study assessed immediate gains after intervention, their maintenance over 2 months, and their effect on diagnostic status at both time points. METHODS: Participants included 15 children (57.7 months SD 7.8) diagnosed with developmental language disorder: 3 monolinguals and 12 bilingual immigrants. Intervention targeted vocabulary and syntax. Assessment of intervention targets and standardized testing was conducted before, after, and 2 months after treatment. Diagnostic status and severity level were assessed at each time point. RESULTS: Intervention was highly efficacious with large effect sizes for intervention targets. However, for diagnostic status, efficacy was more questionable. Seven children improved their diagnostic status from pre- to posttest; but many dropped back at maintenance point. For 3 children, all test time showed scores within the non-impaired range, indicating misdiagnosis or change in status while waiting for treatment. Amount of pain was not correlated with any background variable. CONCLUSIONS: Results suggest that intervention could be more efficacious by giving more therapy sessions and conducting evaluation and treatment closer in time.