Using Hierarchical Linear Modeling to Examine How Individual SLPs Differentially Contribute to Children's Language and Literacy Gains in Public Schools

Group Size: An Active Ingredient of School-Based Language Therapy

PURPOSE

This study explored the relation between therapy group size and language outcomes for children receiving school-based language therapy through an implementation science lens.

METHOD

Data for the current study were gathered as part of the Speech-Language Therapy Experiences in Public Schools study. Participants included 273 English-speaking kindergarten through second-grade children with language impairment receiving business-as-usual therapy on the caseloads of 75 speech-language pathologists. Data were collected over an academic year, including weekly therapy logs, speech-language pathology questionnaires, and pre- and post-language measures.

RESULTS

Descriptive analysis revealed that children primarily experienced small-group therapy sessions (two to four children); however, there was considerable variability in group size. Hierarchical general linear modeling indicated that caseload size did not explain group size variability. However, the number of student cancellations was positively associated with receipt of large-group sessions. Notably, a significant negative association was found between receipt of large-group sessions (i.e., five to 10 children) and language outcomes. Children who received more than the average number of sessions in large groups (i.e., more than 5% of total sessions) experienced 0.18 SD less language gain over the academic year compared to the mean (0.54 SD). No other group size configurations (i.e., individual, small group, and extra large) yielded significant associations with language outcomes.

CONCLUSIONS

The findings suggest that young children receiving language-based therapy in large groups make substantially fewer language gains over an academic year. These results have considerable implications for educational policy and clinical practice, which are discussed through an implementation science frame.

Conceptions and Misconceptions: What Do School-Based Speech-Language Pathologists Think About Dyslexia?

PURPOSE

The purpose of this exploratory study was to evaluate speech-language pathologists' (SLPs') conceptions and misconceptions about dyslexia.

METHOD

Participants were 86 school-based SLPs. They completed an online survey on which they rated their agreement and disagreement with true and false statements related to the scientific evidence about the nature of dyslexia and interventions for dyslexia, as well as common misconceptions about dyslexia.

RESULTS

There was considerable variability among SLPs' agreement and disagreement with the statements. Critically, despite abundant contrary evidence in the literature, many SLPs believe that dyslexia involves a visual processing deficit.

CONCLUSIONS

These findings suggest that many school-based SLPs hold misconceptions about dyslexia, especially those related to dyslexia being a visual disorder. The identified misconceptions may contribute to some SLPs' reluctance to incorporate reading and prereading skills into speech-language assessment and intervention. SLPs need greater knowledge of dyslexia to provide more effective evaluations and intervention services.

Variation in morpho-lexical development within and between diagnoses in children with neurodevelopmental disorders

While primary diagnosis is only one aspect of the presentation of a child with neurodevelopmental delay/disorder, the degree to which early expressive language reflects diagnostic divisions must be understood in order to reduce the risk of obscuring clinically important differences and similarities across diagnoses. We present original data from the New Zealand MacArthur-Bates Communicative Development Inventory (NZCDI) from 88 English-speaking children aged 2;6 to 5;6 years receiving multidisciplinary intervention within a single family-centered program. The children had one of six pediatrician-assigned genetic or behaviorally determined diagnoses: Down syndrome (DS); motor disorders (cerebral palsy and developmental coordination disorder); global development delay; disorders of relating and communicating (R&C); other genetically defined diagnoses; or language delay due to premature (PREM) birth. Morphological and lexical development were compared within and across diagnostic groups, using both data visualization and mixed-effects modeling. Groups varied in the amount of variation within and between them, but only prematurity reached significance, in interaction with age, as a predictor of morpho-lexical scores. Further analysis of longitudinal data available from a subset of the sample (n = 62) suggested that individual trajectories of vocabulary growth could not be reliably predicted by diagnosis. Moreover, the distribution of word types (nouns, predicates, etc.) only distinguished PREM children with language delay from those with DS and those in the R&C group. There were strong similarities in early morpho-lexical development across these clinical populations, with some differences. These findings align with research and clinical approaches which accommodate individual variation within diagnosis, and broad similarities across diagnostic groups.

Using the Experience Sampling Method to Examine the Details of Dosage in School-Based Speech Sound Therapy

PURPOSE

The purpose of this project was to collect practice-based evidence regarding dosage in speech sound therapy sessions in school-based settings. Dosage is the number of trials within a therapy session for any one particular child. School-based speech-language pathologists (SLPs) face a variety of obstacles to service delivery, often making the implementation of evidence-based practices difficult. To that end, we were interested in exploring how therapy parameters, such as group size and session frequency were associated with dosage.

METHOD

Using the experience sampling method, we queried school-based SLPs (n = 90) across the United States. SLPs participated via a phone application, which randomly alerted them to participate 3 times per day for 5 days. SLPs also completed a demographic questionnaire that included information regarding caseload size and job satisfaction.

RESULTS

We report results from 670 therapy sessions. Results revealed that the therapy parameter of group size was negatively related to dosage. The SLP parameter of caseload size was positively related to dosage, but this was a small association. The child parameter of comorbidity was negatively related to dosage.

CONCLUSIONS

Our results support that as group size increases, children receive smaller doses of speech sound practice. Similarly, children who have a reported comorbidity received smaller doses compared to children who have an isolated speech sound disorder. We discuss implications for school-based practitioners and researchers.

The Development of Clinical Self-Efficacy in Speech-Language Pathology Graduate Training: A Longitudinal Study

PURPOSE

The study examined the development of speech-language pathology (SLP) trainee clinical self-efficacy (CSE)-defined as an individual's confidence in performing tasks related to speech and language assessment and intervention-over the course of graduate clinical training. The study also examined the relationship between preprogram experience and CSE as well as the relationship between trainee self-efficacy and clinical performance.

METHOD

Participants, two cohorts of full-time SLP graduate trainees (N = 75), completed a novel SLP-specific measure of CSE at the beginning, middle, and end of a 2-year master's program and provided background information and access to practicum evaluations.

RESULTS

CSE increased significantly at each point of assessment (p < .001). Students reported lower levels of self-efficacy for tasks related to evaluation compared to administration/report writing, collaboration, communication, and counseling (p < .001). Results also showed lower levels of intervention-related CSE compared to collaboration (p < .001) communication and counseling (p < .05). The variability in task-specific confidence decreased as training progressed; however, students' confidence in their evaluation skills continued to be lower relative to administration/report writing (p < .05) and collaboration (p < .01). Participants' prior clinical experience and preprogram training did not predict CSE; however, trainees with an undergraduate Communication Disorders (CD) major reported greater end-of-program self-efficacy than non-CD majors (p < .05). Trainee CSE was not found to be related to instructors' assessment of clinical performance.

CONCLUSION

Findings provided preliminary insights into the nature and development of SLP-specific CSE over the course of graduate training and point to the potential pedagogical value of further examining factors associated with graduate trainee CSE in the context of clinical education.

How to Recruit, Support, and Retain Speech-Language Pathologists in Public Schools

Over the past two decades, there has been a persistent shortage of qualified speech-language pathologists (SLPs) across the United States. This shortage is predicted to continue, as data reported by the American Speech Language Hearing Association (ASHA) from the US Bureau of Labor Statistics indicates that there will be a 27% increase in job openings through the year 2028. In some states, the shortage has led to service provision from individuals without a background in speech-language pathology and/or without speech-language pathology certification and licensure. Speech and language services that are delivered by unqualified personnel may lead to inadequate time devoted to therapy—either too much, or too little—which is ultimately unethical, illegal, and expensive. However, there is a real issue at hand for school leadership—and that is: How to recruit, support, and retain highly qualified SLPs? In the current tutorial, we will provide evidence-based action steps for how and why to recruit, support, and retain certified and licensed SLPs. Specifically, we discuss the qualifications of the SLP, roles and responsibilities of school-based SLPs, caseload versus workload considerations, various service delivery models, and a review of SLP job satisfaction research. Throughout the tutorial, we will provide concrete and evidence-based ideas for school leadership to consider when recruiting, supporting, and retaining SLPs.

Speech-Language Pathologists' Clinical Decision Making for Children With Specific Language Impairment

Purpose The speech-language pathologist's (SLP's) role for the specific language impairment (SLI) population is to provide specialized intervention targeting underlying deficits. However, children with SLI are often underrepresented on caseloads despite a high prevalence of the disorder and known long-term impacts. This study explored how SLPs use research to inform clinical decision making for SLI under neutral workplace circumstances. Method A national web-based survey was distributed to SLPs ( n = 563) to investigate assessment and intervention clinical decision making for individuals with SLI. Vignettes portrayed various clinical profiles of SLI across dimensions of affectedness (child characteristics). Respondents made clinical decisions under neutral workplace conditions to remove confounds of work setting, policies, and caseload/time management constraints. The influence of child and practitioner characteristics on clinical decision making was explored. Results Variation across the vignettes emerged for the clinical decisions of SLP service recommendation, service delivery, intervention contents, specific treatment goals, and a monitoring approach. Practitioner characteristics had little influence, while child characteristics influenced responses across the clinical decision-making process. Assessment standard scores and percentiles were most strongly associated with SLP service recommendation. Conclusion The use of vignette methodology was demonstrated for the discipline of communication sciences and disorders. SLPs recommended services for individuals with SLI at higher rates than in actual practice; however, variation across the clinical decision-making process occurred. Implications include the reduction and removal of constraining workplace characteristics and increasing SLP competency for identifying the diagnostic profile of SLI.

Contributions to Gain in Speech Sound Production Accuracy for Children With Speech Sound Disorders: Exploring Child and Therapy Factors

Purpose The purpose of this study was to explore the extent to which child- and therapy-level factors contribute to gains in speech sound production accuracy for children with speech sound disorders in receipt of school-based services. Method Data were obtained from 126 kindergarten and first- and second-grade children currently in receipt of speech therapy services in their public school setting. Pretest and posttest measures of spontaneous speech production and language ability were collected at the beginning and end of one academic year. Using a spontaneous speech sample, percentage of consonants correct (PCC) was calculated for each child; a gain score was computed by subtracting the pretest PCC score from the posttest PCC score. The children's speech-language pathologist completed weekly therapy logs during business-as-usual therapy, indicating the frequency, duration, and group composition of services throughout the school year. Results Results supported that gain in PCC from pretest to posttest was predicted by several child- and therapy-level variables. Children's initial speech sound severity was negatively related to gains in PCC. Our results also supported that the total number of therapy sessions received in a year was positively predictive of PCC gain. Interestingly, the number of individual therapy sessions was negatively associated with PCC gain. Conclusion Several malleable therapy factors contribute to gains in speech sound accuracy for children with speech sound disorders. Speech-language pathologists should consider how these factors may be manipulated to best tailor treatment to the individual needs of the children on their caseloads.

Cluster-Randomized Controlled Trial Evaluating the Effectiveness of Computer-Assisted Intervention Delivered by Educators for Children With Speech Sound Disorders

PURPOSE

The aim was to evaluate the effectiveness of computer-assisted input-based intervention for children with speech sound disorders (SSD).

METHOD

The Sound Start Study was a cluster-randomized controlled trial. Seventy-nine early childhood centers were invited to participate, 45 were recruited, and 1,205 parents and educators of 4- and 5-year-old children returned questionnaires. Children whose parents and educators had concerns about speech were assessed (n = 275); 132 children who were identified with phonological pattern-based errors underwent additional assessment. Children with SSD and no difficulties with receptive language or hearing, typical nonverbal intelligence, and English as their primary language were eligible; 123 were randomized into two groups (intervention n = 65; control n = 58), and 3 withdrew. The intervention group involved Phoneme Factory Sound Sorter software (Wren & Roulstone, 2013) administered by educators over 9 weeks; the control group involved typical classroom practices. Participants were reassessed twice by a speech-language pathologist who was unaware of the initial assessment and intervention conditions.

RESULTS

For the primary outcome variable (percentage of consonants correct), the significant mean change from pre- to postintervention for the intervention group (mean change = +6.15, p < .001) was comparable in magnitude to the significant change for the control group (mean change = +5.43, p < .001) with a small between-groups effect size for change (Cohen's d = 0.08). Similar results occurred for measures of emergent literacy, phonological processing, participation, and well-being.

CONCLUSION

Computer-assisted input-based intervention administered by educators did not result in greater improvement than typical classroom practices.

Predictors of Language Gains Among School-Age Children With Language Impairment in the Public Schools

PURPOSE

This study aimed to identify child-level characteristics that predict gains in language skills for children with language impairment who were receiving therapy within the public schools. The therapy provided represented business-as-usual speech/language treatment provided by speech-language pathologists in the public schools.

METHOD

The sample included 272 kindergartners and first-graders with language impairment who participated in a larger study titled "Speech-Therapy Experiences in the Public Schools." Multilevel regression analyses were applied to examine the extent to which select child-level characteristics, including age, nonverbal cognition, memory, phonological awareness, vocabulary, behavior problems, and self-regulation, predicted children's language gains over an academic year. Pratt indices were computed to establish the relative importance of the predictors of interest.

RESULTS

Phonological awareness and vocabulary skill related to greater gains in language skills, and together they accounted for nearly 70% of the explained variance, or 10% of total variance at child level. Externalizing behavior, nonverbal cognition, and age were also potentially important predictors of language gains.

CONCLUSIONS

This study significantly advances our understanding of the characteristics of children that may contribute to their language gains while receiving therapy in the public schools. Researchers can explore how these characteristics may serve to moderate treatment outcomes, whereas clinicians can assess how these characteristics may factor into understanding treatment responses.

Assistive technology as reading interventions for children with reading impairments with a one-year follow-up

PURPOSE

This pilot study investigated the possible transfer effect on reading ability in children with reading difficulties after a systematic intervention to train and compensate for reading deficiencies by using applications in smartphones and tablets. The effects of using assistive technology (AT) one year after the interventions were completely studied. School related motivation, independent learning and family relations were also considered.

METHOD

35 pupils aged 10-12 years participated. They were assessed five times with reading tests. The participants, their parents and teachers were surveyed with questionnaires regarding their experience of using AT. The data from the assessments were analyzed with paired t-tests and Wilcoxon signed-rank tests. The data from the questionnaires were analyzed using content analysis.

RESULTS

The paper shows that using AT can create transfer effects on reading ability one year after the interventions were finished. This means that reading impaired children may develop at the same rate as non-impaired readers. Also, increased school motivation and an increase in independent learning and family effects have been shown.

CONCLUSIONS

This paper provides implications in how to facilitate reading impaired pupils' learning process and realizes the need to challenge the concept of reading to change to fit modern means of gaining information. Implications for rehabilitation Children with reading impairment could benefit from assistive technology in regards of their reading development process and increase their chances of not falling behind peers. Assistive technology as applications in smartphones and tablets may aid children with reading impairment to have an equal platform for learning in school as their peers without reading difficulties. Assistive technology could facilitate the information gaining process and subsequently increase motivation to learn and increase interest in reading activities. Assistive technology had wider effects on its users: stigmatizing situations when leaving the classroom for special education were avoided and positive effects on family life were noted.