Core outcomes for speech-language services in Ontario schools: a group concept mapping study and guiding framework.

BACKGROUND: Establishing the most important outcomes for school-based speech-language therapy is essential to guide future research and program evaluation for these services. Many health disciplines have developed core outcomes sets (COS) for this purpose. A COS encompasses the most important outcomes for particular health services as identified by appropriate interested parties. These interested parties usually represent health care providers and those with the health condition. In this paper, we report the development of a guiding framework for a COS for speech-language therapy services in schools in a Canadian context. METHODS: Using a group concept mapping method, we identified the outcomes for inclusion in the COS guiding framework through the elicited opinions of key interested parties: speech-language therapists, teachers, and family members of children with speech, language, and communication needs. We extracted 103 statements (potential outcomes) from a previous data set of interview transcripts. We then asked participants to sort the statements into conceptually similar groups, which were aggregated and transformed into a cluster map using multidimensional scaling followed by hierarchical cluster analysis. Participants also rated each statement on 5-point scales for importance and feasibility. We calculated mean ratings for individual statements and for all statements in a cluster, for all participants and for participant groups separately. RESULTS: We identified seven core outcomes for school-based speech-language services in Ontario, Canada. These included: classroom-based services, a holistic approach, support for teachers, care coordination, accessible services, family supports, and student success. All outcomes were rated highly for importance. Feasibility ratings were consistently below importance ratings. All participant groups concurred that a holistic approach was the most important outcome and accessible services was the least feasible outcome to achieve. CONCLUSIONS: The seven outcomes identified in this study are recommended to guide the development of a full COS to direct future research and program evaluation for school-based speech-language services. These outcomes have not been widely included in previous research and should be incorporated into future research alongside specific intervention outcomes. Data for some outcomes may be available from non-traditional sources such as administrative data sets. Consequently, their use for program evaluations should be accompanied by appropriate institutional support to allow speech-language therapists to make meaningful use of appropriate outcomes data.

School-Based Occupational Therapists' Roles Supporting Transitions Into and Throughout Kindergarten to Grade 12: A Scoping Review.

IMPORTANCE: Large educational transitions occur when students enter and exit school or move between grades or divisions within the kindergarten to Grade 12 (K-12) school system. For students with disabilities, the quality of large educational transitions affects academic and postschool outcomes, which is germane to school-based occupational therapists. OBJECTIVE: To explore the school-based occupational therapy literature to describe the roles of occupational therapists in supporting large educational transitions and to identify relevant terminology. DATA SOURCES: We searched six databases (CINAHL, EMCare, Embase, ERIC, MEDLINE, and PsycINFO) for peer-reviewed publications in English with no date limitations. STUDY SELECTION AND DATA COLLECTION: We included articles focused on children and youth with disabilities and school-based occupational therapy services supporting large transitions within K to 12 education. Using directed content analysis, we reported on publication characteristics, occupational therapy roles, and terminology. FINDINGS: We included 46 publications spanning 37 yr that addressed transitions into school (n = 3), within K to 12 grades or divisions (n = 10), or to exit secondary education (n = 33). Occupational therapists assumed many roles in supporting large transitions, some much more frequently than others; 125 transition terms were used across included articles with few terms explicitly defined. CONCLUSIONS AND RELEVANCE: School-based occupational therapists' involvement in educational transitions is extensive, with potential for expansion. Consistency in terminology would support future research and practice. Plain-Language Summary: A large educational transition occurs when students move between a school, grade, or division as part of their K to 12 education. For students with disabilities, the quality of a large educational transition affects their academic and postschool outcomes. This review provides an understanding of how school-based occupational therapists support educational transitions for youth with disabilities. The review found that occupational therapists took on many roles, with the potential for expanding their roles. The review also identified 125 transition terms that were used across the literature review and found that few terms were explicitly defined. Consistency in terminology would support future research and expanded occupational therapy practice in this area.

Outcomes management practices in tiered school-based speech-language therapy: A Canadian example.

BACKGROUND: Measuring, assessing and managing outcomes in school practice environments is difficult due to the complex nature of school communities as well as the recent shift in service-delivery models towards tiered approaches. In tiered approaches, multiple levels of service are offered to better match students' needs. Each level of service may require different outcomes and management techniques. Research to date on outcomes has focused on measuring outcomes in medical settings, leaving a substantive gap in the literature regarding practice in schools. AIMS: The first aim was to explore how school-based speech-language therapists approached outcomes management as their clinical programmes transitioned to tiered service-delivery models The second aim was to describe the successes and challenges in outcomes management reported by clinicians in this context. METHODS & PROCEDURES: A secondary deductive-inductive content analysis was performed using qualitative interviews with 24 clinical managers and senior therapists from schools across Ontario, Canada. Using a framework of outcomes measurement, assessment and management in schools based on previous research studies, data were grouped into broad categories deductively, and then the content of each category was further explored using inductive coding. Iterative peer debriefing and reflexive journaling were key strategies to increase the trustworthiness of the results. FINDINGS & RESULTS: Participants reported measuring and qualitatively assessing seven key outcomes for school-based practice. These included: (1) student progress and achievement, (2) student participation and inclusion in the school community, (3) stakeholder perspectives, (4) 'buy-in', (5) expanded capacities, (6) responsiveness to needs and (7) accountability to systems. Participants reported more challenges than successes in outcomes management during this transition to tiered services. Challenges were attributed to idiosyncratic organizational barriers, the transition to tiered models and the philosophy of working within the educational system. CONCLUSIONS & IMPLICATIONS: School-based speech-language therapists measure, assess and manage multiple outcomes relevant to school-based practice in tiered service-delivery models. Many challenges remain. Solutions to support meaningful, systematic and proactive outcomes management in schools should address the broader set of outcomes relevant to tiered service-delivery models and the unique practice context of the educational system, while remaining responsive to idiosyncratic organizational factors. Sustained clinical-research collaboration and knowledge exchange is recommended. WHAT THIS PAPER ADDS: What is already known on the subject Systematic, proactive collection and interpretation of outcomes has long been encouraged within speech-language therapy. However, implementing outcomes management in clinical practice remains a substantial challenge. Additionally, research on outcomes to date has focused on medical practice environments, to the exclusion of school-based practice. What are the potential or actual clinical implications of this work? Outcomes management is valued in school practice environments; however, the current repertoire of techniques for outcomes management are a poor match for school-based practice. Clinicians in schools would benefit from the development of contextually relevant, meaningful and feasible outcomes management tools.

Self-esteem mediates mental health outcomes in young people with epilepsy.

OBJECTIVE: To evaluate the extent to which self-esteem mediates the impacts of epilepsy-specific and environmental factors on mental health outcomes in young people with epilepsy. METHODS: A prospective cohort of 480 young people with epilepsy and their families participated in five visits over 28 months. We collected data on clinical seizure burden, cognitive comorbidity, peer and parental support, self-esteem, and self-reported mental health symptoms. We used structural equation modeling to specify and test relationships among these constructs simultaneously. Direct, indirect, and total effects were estimated with confidence intervals constructed through bias-corrected bootstrapping. RESULTS: Self-esteem mediated the effects of clinical seizure burden ( ß  = 0.23, 95% confidence interval [0.05, 0.42]) and peer support ( ß  = -0.15, 95% CI [-0.28, -0.03]) on mental health. There were no mediating effects of parental support ( ß  = -0.07, 95% CI [-0.14, 0.00]) or cognitive comorbidity ( ß  = -0.01, 95% CI [-0.02, 0.01]) on mental health. SIGNIFICANCE: We found evidence that self-esteem mediates the impact that both clinical seizure burden and peer support have on mental health outcomes, indicating that assessment of and interventions targeting self-esteem may be appropriate for young people with epilepsy. Supporting self-esteem could mitigate negative influences on mental health, whether from resistant epilepsy or low peer support.

Health professional-educator collaboration in the delivery of school-based tiered support services: A qualitative case study.

BACKGROUND: Educators and health professionals support the learning and participation of diverse children in school environments. Tiered approaches to service delivery may assist these efforts through consideration of universal supports that are useful to all children, targeted supports for some children and individualized supports for the smallest number of children. This study explored how an interprofessional team worked with educators to develop and implement tiered services in two school communities where many families experience economic and social disadvantages. METHODS: Using a participatory action research approach and qualitative case study methods, the research and stakeholder teams jointly designed and conducted this study in two schools during the 2017-2018 school year. Data collected included weekly logs written by the interprofessional team members and 16 interviews conducted with team members, parents, educators and administrators. RESULTS: The team provided a variety of services to individual students, groups, whole classes and the school community. Collaboration and communication were needed to define roles and expectations and to plan and share student information. Reported benefits included timely service, capacity building and student goal achievement. The main barriers were related to service fragmentation, time and workload. CONCLUSIONS: Recommendations included clearer direction about expectations and improved coordination within the systems that offer services. Further research should include exploration of comparative cases with varying contexts, the inclusion of child perspectives and direct observation.

Recommended practices to organize and deliver school-based services for children with disabilities: A scoping review.

BACKGROUND: Inclusive educational environments can have a positive effect on the general health and well-being of children with disabilities. However, their level of academic success and participation remains limited. Considering scarce resources and high needs, identifying efficient methods for providing interdisciplinary services is critical. This scoping review, therefore, aims to (a) synthesize current evidence about principles for organizing and delivering interdisciplinary school-based support services for students with disabilities and (b) ascertain useful strategies for implementation of principles in the school setting. METHODS: Scholarly and grey literature in rehabilitation and education were reviewed collaboratively with school-based stakeholders. A search of five databases identified 13,141 references and resulted in 56 relevant articles published from 1998 to 2017. Information (e.g., principles to organize services and strategies for implementation) was extracted, and thematic analysis was used to summarize findings. RESULTS: Within the documents retained, 65% were scientific and 35% were grey. Services primarily targeted students with behavioral issues, followed by those with cognitive and learning disabilities with a focus on improving social-emotional functioning and academic performance. Thematic analysis revealed 10 common principles to guide service organization (e.g., collaborative interventions and support for teachers) and seven implementation strategies (e.g., training and coordination) for employing these principles. CONCLUSIONS: Findings can guide rehabilitation professionals, educators, and policy makers in restructuring well-coordinated collaborative services involving training and capacity-building of school-based service providers. Such knowledge can contribute to the improved provision of care and, consequently, promote children's school participation and inclusion.

Exploring the valued outcomes of school-based speech-language therapy services: a sequential iterative design.

Background: Achieving outcomes that community members value is essential to high-quality, family-centred care. These valued outcomes should inform the production and interpretation of research evidence. To date, outcomes included in studies of service delivery models for speech-language services in schools have been narrowly defined, and do not match the outcomes suggested as important by families, teachers, and children. The most important outcomes of school-based, speech-languages services have not been directly and systematically investigated. We aimed to address this gap by asking school community members what outcomes were most relevant to evaluating and improving the delivery of speech-language services in schools. Methods: A sequential, iterative mixed-method study was conducted using interviews with 14 family members, educators, and speech-language therapists that asked what outcomes or impacts of school-based services they considered most important or valuable. Summative content analysis was used to analyse the data. Structural topic modelling between rounds of qualitative analysis was used to describe both the quality and the quantity of the interview content. School community members' perspectives were compared through estimation of topic proportions within interviews from each member group and through qualitative comparison. Results: Structural topic modelling diagnostics and qualitative interpretation of topic output suggested a six-topic solution. This solution was estimated successfully and yielded the following topics: (1) meeting all needs appropriately, (2) teamwork and collaboration, (3) building capacities, (4) supporting individual student needs in context, (5) coordinating care, and finally (6) supporting core educational goals. Families focused on school-based services meeting all needs appropriately and coordinating care, while educators highlighted supporting individual student needs in context. By contrast, speech-language therapists emphasized building capacities and supporting core educational goals. All school community members agreed that current assessment tools and outcome measures were inadequate to capture the most important impacts of school-based services. Conclusions: Outcomes identified by school community members as important or valuable were broad, and included individual student outcomes, interpersonal outcomes, and systems-level outcomes. Although these outcomes were discussed by all member groups, each group focused on different outcomes in the interviews, suggesting differences in the prioritization of outcomes. We recommend building consensus regarding the most important outcomes for school-based speech-language services, as well as the prioritization of outcomes for measure development.

Partnering for Change: collaborating to transform occupational therapy services that support inclusive education.

The United Nations champions inclusive education as a moral obligation, requiring equitable learning environments that meet all individuals' diverse learning needs and abilities, including children and youth. Yet the practice of inclusive education is variable and implementation challenges persist. A participatory action research framework was used to develop a solution, Partnering for Change (P4C), which is a tiered service delivery model that bridges health and education by re-envisioning occupational therapy services and transforming the role of the occupational therapist from a service provider for individual children to a collaborative partner supporting the whole school community. This perspective article will describe the P4C model and its evolution, and will outline how it has been implemented in Canadian and international contexts to facilitate children's inclusion and participation in educational settings.

Reporting of Classroom-Based Morphological Awareness Instruction and Intervention for Kindergarten to Grade 3 Students in the Literature: A Scoping Review.

PURPOSE: The purpose of this scoping review was to document how the literature reports morphological awareness instruction and interventions delivered by speech-language pathologists (SLPs) and/or educators in classroom settings for kindergarten to Grade 3 students. METHOD: We followed the Joanna Briggs Institute's methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews reporting guidelines. Six relevant databases were searched systematically with article screening and selection completed by two reviewers calibrated for reliability. For data charting, one reviewer extracted content and a second reviewer verified it was pertinent to the review question. Charting for the reported elements of morphological awareness instruction and interventions was guided by the Rehabilitation Treatment Specification System. RESULTS: The database search yielded 4,492 records. After removal of duplicates and screening, 47 articles were selected for inclusion. Interrater reliability for source selection exceeded the pre-established criterion of k = .61. Our analysis generated a comprehensive description of the elements of morphological awareness instruction as reported in the included articles. CONCLUSIONS: Our findings provide school-based SLPs and educators a systematic means of reviewing the literature to identify key elements of morphological awareness instruction in published articles for application of evidence-based practices with fidelity, thus helping to close the research-to-practice gap. Our manifest content analysis revealed reporting of the elements for classroom-based morphological awareness instruction was varied, and in some cases, underspecified in the articles included in our study. Implications for clinical practice and future research to advance knowledge and promote implementation of evidence-based practices by SLPs and educators in today's classrooms are discussed. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22105142.

Establishing and sustaining authentic organizational partnerships in childhood disability research: lessons learned.

There is an increased interest from both researchers and knowledge users to partner in research to generate meaningful research ideas, implement research projects, and disseminate research findings. There is accumulating research evidence to suggest the benefits of engaging children/youth with disabilities and their parents/families in research partnerships; however, less is known about the benefits of, and challenges to, engaging organizations as partners in research. The purpose of this commentary is to reflect on successful organizational partnership experiences from the perspectives of researchers at an internationally-recognized childhood disability research centre (CanChild), and to identify and share key ingredients for developing partnerships between organizations and academic institutions. A companion study is underway to examine partnership experiences with CanChild from the partners' perspective. Four CanChild researchers and two co-facilitators participated in a collaborative auto-ethnography approach to share experiences with organizational research partnerships and to reflect, interpret, and synthesize common themes and lessons learned. The researchers and facilitators met virtually via Zoom for 105 min. Researchers were asked to discuss the following: the formation of their organizational partnerships; if/how partnerships evolved over time; if/how partnerships were sustained; and lessons learned about benefits and challenges to building research partnerships with organizations. The meeting was recorded, transcribed verbatim, and analyzed by the facilitators to identify and synthesize common experiences and reflections. Multiple rounds of asynchronous reflection and feedback supported refinement of the final set of analytic themes. Researchers agreed that partnerships with organizations should be formed through a mutual interest, and that partnerships evolved by branching to include new organizations and researchers, while also involving trainees. Researchers identified the importance of defining roles and responsibilities of key individuals within each partnering group to sustain the partnership. Lessons learned from organizational partnerships included reciprocity between the partnering organization and academic institution, leveraging small pockets of funds to sustain a partnership over time, and building a strong rapport with individuals in a partnership. This commentary summarized lessons-learned and provided recommendations for researchers and organizations to consider when forming, growing, and sustaining research partnerships over time.

Researchers and people who use research findings are partnering to create research projects and share results. There are examples of children with disabilities and their families participating in research partnerships, but less is known about the involvement of healthcare organizations and community organizations as research partners. The purpose of this article is to share successful examples of partnership between organizations and a childhood disability research centre from the perspective of researchers. Four researchers and two facilitators met to reflect on their experiences with organizational research partnerships. They met online for 105 min using Zoom software. The researchers were asked to talk about how their partnerships with organizations were formed, how they grew over time, and how they were maintained. The meeting was recorded, and the facilitators took the researchers' experiences and summarized them into common messages. Everyone then read the summary on their own and added their ideas. This happened three different times until everyone agreed on one set of ideas. The researchers agreed that partnerships with organizations should be formed through common goals, that they should grow to include new partners and junior researchers, and that clear roles and responsibilities were needed to keep the partnership going. The experiences shared in this article are valuable to other researchers and organizations that are interested in forming research partnerships.

Supporting rehabilitation stakeholders in making service delivery decisions: a rapid review of multi-criteria decision analysis methods.

PURPOSE: This review aimed to synthesize knowledge about multi-criteria decision analysis methods for supporting rehabilitation service design and delivery decisions, including: (1) describing the use of these methods within rehabilitation, (2) identifying decision types that can be supported by these methods, (3) describing client and family involvement, and (4) identifying implementation considerations. METHODS: We conducted a rapid review in collaboration with a knowledge partner, searching four databases for peer-reviewed articles reporting primary research. We extracted relevant data from included studies and synthesized it descriptively and with conventional content analysis. RESULTS: We identified 717 records, of which 54 met inclusion criteria. Multi-criteria decision analysis methods were primarily used to understand the strength of clients' and clinicians' preferences (n = 44), and five focused on supporting decision making. Shared decision making with stakeholders was evident in only two studies. Clients and families were mostly engaged in data collection and sometimes in selecting the relevant criteria. Good practices for supporting external validity were inconsistently reported. Implementation considerations included managing cognitive complexity and offering authentic choices. CONCLUSIONS: Multi-criteria decision analysis methods are promising for better understanding client and family preferences and priorities across rehabilitation professions, contexts, and caseloads. Further work is required to use these methods in shared decision making, for which increased use of qualitative methods and stakeholder engagement is recommended. IMPLICATIONS FOR REHABILITATIONMulti-criteria decision analysis methods are promising for evidence-based, shared decision making for rehabilitation.However, most studies to date have focused on estimating stakeholder preferences, not supporting shared decision making.Cognitive complexity and modelling authentic and realistic decision choices are major barriers to implementation.Stakeholder-engagement and qualitative methods are recommended to address these barriers.

"Support for everyone": Experiences of occupational therapists delivering a new model of school-based service.

BACKGROUND: Occupational therapists working in school health have recognized the need to move away from a one-to-one direct service delivery model towards a more collaborative, classroom-based approach. Partnering for Change (P4C) is an innovative service delivery model that may enhance school-based collaborative care. PURPOSE: To capture the experiences of occupational therapists implementing P4C and to elicit their perspectives about how this model differs from the direct service approach. METHODS: Semi-structured, face-to-face interviews were conducted with seven therapists who had delivered P4C in 10 Ontario schools. Thematic analysis was utilized with themes verified through member checking. FINDINGS: Five themes (a year of growth, becoming a community, the key ingredients of P4C, a balancing act, and providing services that make an impact) reflected therapists'personal and professional growth, aspects of the model they believed were key, challenges they encountered, and the impact they felt they had made. IMPLICATIONS: Partnering for Change has the potential to transform school-based occupational therapy and overcome existing barriers to collaboration. This model also may better address the needs of children with motor coordination difficulties.

Partnering for change: an innovative school-based occupational therapy service delivery model for children with developmental coordination disorder.

BACKGROUND: Developmental coordination disorder (DCD) is a common, chronic health condition that is poorly recognized and understood in school settings. Without appropriate support, children with DCD are at increased risk of depression, decreased fitness, and obesity. Evidence shows that occupational therapy intervention needs to shift from remediation of impairment to chronic disease management. PURPOSE: This paper describes Partnering for Change (P4C), an innovative, empirically derived school health service delivery model for children with DCD. KEY ISSUES: The model emphasizes the partnership of the occupational therapist with educators and parents to change the life and daily environment of a child. The P4C partnership focuses on capacity building through collaboration and coaching in context. The model uses a tiered approach which includes whole class instruction, dynamic performance analysis, and monitoring response to intervention. IMPLICATIONS: P4C is a model that responds to the needs of this population, addresses issues identified in research, and provides a continuum of services designed to build capacity.

Implementing Partnering for Change in Québec: Occupational Therapy Activities and Stakeholders' Perceptions.

BACKGROUND.: The occupational therapy school-based Partnering for Change (P4C) model has mostly been documented in Ontario. PURPOSE.: This implementation study describes the implementation of P4C in two Québec elementary schools (P4C-Q), as well as therapy practices, their impacts, factors perceived to influence implementation, and recommendations. METHOD.: A sequential mixed-methods design was applied. Therapists (n=2) completed daily journals, describing activities by P4C-Q level. Therapists and other school-stakeholders (n=11) participated in semi-structured interviews, analyzed through a content analysis framework. FINDINGS.: Daily journals illustrated that the majority of therapy time was spent on activities targeting the entire classroom, and on collaboration with educators. Interviews illustrated how coaching was used across different practices and the impact of these practices for schools (e.g., capacity-building) and children (e.g., increased functioning), and highlighted how relationship-building is key to facilitating the implementation of this model. IMPLICATIONS.: Lessons learned may be helpful for others implementing P4C in their own contexts.

Validity of the Early Years Check-In (EYCI) in a Cross-Sectional Sample of Families.

Background: The objective of the present study was to develop and test the validity of the Early Years Check-In (EYCI), a new tool that measures parent and educator concerns regarding children's development. The study examined the EYCI's agreement with 3rd edition of the Bayley Scales of Infant and Toddler Development (BSID-III) an established measure of child development. Two possible thresholds were explored: one to identify children with a probable delay, and another to identify children at the borderline functioning threshold. Methods: Parents of children aged 18 to 42 months were recruited from childcare settings across Ontario, Canada. The study proceeded in two phases. Phase I, intended to pilot the measure, included 49 children. Phase II, a test of the validity of the final version, included 199 children. Parents and educators completed the EYCI for the child, while a blinded assessor completed the BSID-III. Results: The EYCI demonstrated good sensitivity and specificity (86 and 82%, respectively) as a parent-completed tool that identifies children with a probable delay. However, the positive predictive value (15%) suggests the EYCI is likely to over identify children. When identifying children who demonstrated borderline delay, the EYCI demonstrated good sensitivity (80%) but poor specificity (49%). Results from educator-completed EYCIs were poor for both probable and borderline delay. Conclusions: While further research is required, the EYCI shows promise as a parent-completed tool, particularly to identify more-severe cases of delay. Results with educators were poor overall. Future research investigating accuracy of educators in different types of early childcare centres is needed.

Identification of children with language impairment: investigating the classification accuracy of the MacArthur-Bates Communicative Development Inventories, Level III.

PURPOSE: This study tested the accuracy with which the MacArthur-Bates Communicative Development Inventories, Level III (CDI-III), a parent report measure of language ability, discriminated children with language impairment from those developing language typically. METHOD: Parents of 58 children, 49 with typically developing language (age 30 to 42 months) and 9 with language impairment (age 31 to 45 months) completed the CDI-III, a 2-page questionnaire that includes 100 vocabulary items, 12 sentence pairs, and 12 questions regarding linguistic concepts. RESULTS: A discriminant analysis indicated that the CDI-III total score together with age classified children into language status groups with 96.6% accuracy overall. The corresponding likelihood ratios supported this strong level of accuracy, although precision may not be as high as indicated by broad confidence intervals. CONCLUSIONS: Results of this study contribute to the accumulating evidence on the types of valid inferences that may be made from the CDI-III, specifically its classification accuracy. Further research should continue to investigate classification accuracy in larger samples with broader maternal education levels and with different types of language impairments. Additional research should also investigate the classification accuracy when the CDI-III is used in combination with other tests.

Conducting participatory photography with children with disabilities: a literature review.

Purpose: This review summarized studies that used participatory photography with children with disabilities, including those with communication impairments, and described modifications made to the methodology to facilitate their participation in qualitative research. Methods: In the fall of 2016, we searched Psycinfo (OVID), ERIC, CINAHL and Web of Science to identify studies that used participatory photography with children with disabilities. The search was repeated in January 2018 to retrieve any new publications. The first author extracted data that described the characteristics of each study and the modifications used. Results: Of the 258 articles identified, 19 met inclusion criteria. Participants ranged from 4-21 years old and had a variety of disabilities. Study topics included education, leisure activities and adulthood. Researchers modified participatory photography to enhance accessibility by: modifying cameras; providing individual training; teaching consent through role play; allowing children to direct adults to take photographs; including additional forms of media; using diaries and questionnaires; providing individual interviews with simplified questions; using multiple forms of communication; and modifying how photographs are shared. Conclusions: Participatory photography can be an effective method for studying the lived experiences of children with disabilities, particularly those with communication impairments. Methodological modifications can enhance the accessibility of this approach for this population. Implications for Rehabilitation Participatory photography may be an effective qualitative research method for learning about the perspectives and experiences of children with disabilities on a wide array of topics. There are many specific modifications that researchers can use to support the inclusion of children with disabilities in participatory photography research. The findings of studies that use participatory photography methodology may provide rehabilitation professionals with important insights into the lives of children with disabilities.

School-aged children with SLI: the ICF as a framework for collaborative service delivery.

UNLABELLED: Reports of associated disabilities among children with specific language impairment (SLI) and children with other developmental disabilities are widespread. Clinicians require a broader definition of SLI that recognizes associated disabilities because it is their goal to impact children's everyday functioning. In this paper, we explore SLI from a broader perspective in which consideration is given to features known to be common across different developmental disabilities. The World Health Organization's (2001) International Classification of Functioning, Disability and Health (ICF) is utilized as an organizational and conceptual framework for considering how knowledge of commonalities across developmental disabilities may be used to promote collaborative service delivery in an educational setting. This framework can potentially provide a coherent and comprehensive approach to treating SLI and its associated disabilities without overburdening clinical services. LEARNING OUTCOMES: As a result of this activity, the reader will be able to: (1) describe the potential role of the ICF in facilitating collaborative service delivery in the school setting; (2) identify and describe the commonalities among SLI and its associated disabilities; and (3) describe how knowledge of commonalities may inform approaches to service delivery.

A Quasi-Experimental Study of a Movement and Preliteracy Program for 3- and 4-Year-Old Children.

OBJECTIVE: Approximately 28% of children are not ready for kindergarten, 91% are inactive according to current guidelines, and 21% are overweight/obese. Early intervention to strengthen movement and preliteracy skills may help to curb the concerning rates of poor school readiness, inactivity, obesity, and subsequently positively impact health across the lifespan. The objective of this pilot study was to evaluate the effectiveness of a motor and preliteracy skill program for a community sample of 3- to 4-year-old children. METHODS: A quasi-experimental study design was used. The program was run for 1 h/week for 10 weeks and consisted of movement skill instruction, free play, and an interactive reading circle with care-giver involvement throughout each session. Movement and preliteracy skills were assessed in all children pre- and post-intervention using the Peabody Developmental Motor Scales-2nd edition, the Preschool Word and Print Awareness tool, and the Phonological Awareness Literacy Screening tool. RESULTS: Nineteen families (experimental group, n = 8; control group, n = 11) were recruited (mean age = 3 years, 8 m; 47% male). There was a significant effect of group on gross motor raw scores overall [F(1, 16) = 4.67, p < 0.05; [Formula: see text]] and print-concept knowledge [F(1, 16) = 11.9, p < 0.05; [Formula: see text]]. CONCLUSION: This study was one of the first to examine the impact of a community-based movement skill and preliteracy program with care-giver involvement in preschool children. Future research should continue to explore the effects of the program with larger and more diverse samples on multiple health and developmental outcomes. CLINICAL TRIAL REGISTRATION: Play and Preliteracy among Young Children (PLAY) NCT02432443.

Evaluation of a Direct-Instruction Intervention to Improve Movement and Preliteracy Skills among Young Children: A Within-Subject Repeated-Measures Design.

OBJECTIVE: School readiness involves the development of foundational skills such as emergent literacy and fundamental movement skills as well as the capacity to attentively engage in instructional situations. Children do not develop these skills naturally; therefore, they need the opportunity to develop these skills in their early years prior to entering school. The objective of the current study was to evaluate the effectiveness and feasibility of a direct-instruction movement and preliteracy intervention in children aged 3-4 years. METHODS: A within-subject repeated-measures design, embedded within a wait-list control study, was used to evaluate the intervention. The intervention was run across 10 weeks with 1 h weekly sessions. Each weekly session consisted of 30-min of movement skill instruction (e.g., through single-step acquisition strategies), 15-min of free play during which time children had access to a variety of equipment (e.g., balls, hula hoops, etc.) or toys (e.g., puzzles, building blocks), and a 15-min interactive reading circle during which children read a storybook and were taught 1-2 preliteracy skills (e.g., alphabet knowledge, narrative knowledge, etc.). A convenience sample of 11 children (mean age = 45.6 months, SD = 7.3) was recruited. All children were assessed four times: baseline (Time 1), pre-intervention (Time 2), post-intervention (Time 3), and 5-week follow-up (Time 4). Gross motor skills and preliteracy skills were assessed at each time point. RESULTS: There was a statistically significant effect of time on the change in gross motor skills (Wilks' lambda = 0.09, p = .002), print-concept skills (Wilks' lambda = 0.09, p = .001), and alphabet knowledge (Wilks' lambda = 0.29, p = .046). Post hoc analyses reveal non-significant changes between time 1 and 2 for motor and print-concept skills and significant changes in all three outcomes between time 2 and time 3. CONCLUSION: Participation in a direct-instruction movement and preliteracy program led to positive improvements in gross motor skills, print-concept knowledge, and alphabet knowledge in 3- to 4-year-old children over time. Future research needs to evaluate the effectiveness of this movement and preliteracy skill intervention on various other indicators of child development and health. CLINICAL TRIAL REGISTRATION: Play and Pre-Literacy among Young Children (PLAY) NCT02432443.