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Hutchins C, Schmitt MB. Group Size: An Active Ingredient of School-Based Language Therapy. Lang Speech Hear Serv Sch 2024; 55:781-802. [PMID: 38748997 DOI: 10.1044/2024_lshss-23-00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
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.
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Affiliation(s)
| | - Mary Beth Schmitt
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
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Sylvan L, Kingsley H, Bartolett G, Gouck M. A Balancing Act: How School-Based Speech-Language Pathologists Navigate Their Efforts Related to Individual Education Plans and Multi-Tiered Systems of Support. Lang Speech Hear Serv Sch 2024; 55:349-367. [PMID: 38035542 DOI: 10.1044/2023_lshss-23-00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
PURPOSE Speech-language pathologists (SLPs) in public schools have a key role in assessment, intervention, program design, compliance, and prevention. They address the needs of students of all ages and disorders, ensure the educational relevance of their services, and provide culturally competent care. Given the scope of their work, SLPs must balance and prioritize their varying responsibilities in school settings. This study investigates how SLPs navigate their involvement with the prevention-oriented framework Multi-Tiered System of Supports (MTSS) while providing direct support to students with disabilities through Individualized Education Programs (IEPs). METHOD This study took place in a district with a stated goal for the academic year of deepening their involvement with the MTSS framework. Eight SLPs working in this rural district participated in a series of interviews over the course of the 2022-2023 school year. Qualitative data were collected about SLPs' motivations and evolving views related to MTSS. RESULTS While participants in this study were motivated to engage in MTSS because they viewed this framework as a useful mechanism to support students outside of special education, they were limited by time constraints and the challenges of forming collaborative relationships. Each participant navigated the process of balancing their efforts related to MTSS and IEPs in a unique way that reflected their specific setting and circumstances. CONCLUSION This study directly investigated how SLPs navigate this balancing act in real time and provided a novel perspective on the potential synergies and disconnects between SLPs' efforts related to MTSS and their responsibilities related to providing appropriate speech-language services via IEPs.
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Affiliation(s)
- Lesley Sylvan
- Department of Communication Sciences and Disorders, Montclair State University, Bloomfield, NJ
| | - Harmony Kingsley
- Department of Communication Sciences and Disorders, Montclair State University, Bloomfield, NJ
| | - Grace Bartolett
- Department of Communication Sciences and Disorders, Montclair State University, Bloomfield, NJ
| | - Madeleine Gouck
- Department of Communication Sciences and Disorders, Montclair State University, Bloomfield, NJ
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Quinn ED, Kurin K, Atkins KL, Cook A. Identifying Implementation Strategies to Increase Augmentative and Alternative Communication Adoption in Early Childhood Classrooms: A Qualitative Study. Lang Speech Hear Serv Sch 2023; 54:1136-1154. [PMID: 37490621 DOI: 10.1044/2023_lshss-22-00186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
PURPOSE The goal of this study was to identify promising implementation strategies that may increase teachers' and speech-language pathologists' (SLPs) adoption of augmentative and alternative communication (AAC) during routine classroom activities. METHOD A grounded theory approach was used to collect and code online, semistructured interviews with six special education teachers and 14 SLPs who taught children aged 3-8 years who used AAC in inclusive and self-contained special education classrooms. Interviews were transcribed and coded verbatim using the constant comparative method. During a member checking process, six participants (n = 30%) confirmed their transcripts and commented on emerging themes. RESULTS Participants shared a range of implementation strategies to increase AAC use during typical classroom activities, which were organized into seven themes: distribute modern AAC equipment, provide foundational training, share video examples, develop a systematic plan for adoption, deliver practice-based coaching, alter personnel obligations to provide protected time, and connect with professionals. A preliminary thematic map was created to link implementation barriers, strategies, and potential outcomes. CONCLUSIONS AAC interventions effective in clinical research can be difficult to translate into routine practice unless investigators directly explore the needs of and demands on educational professionals. Future research should define implementation strategies clearly, solicit feedback from school-personnel, and match implementation strategies to the needs of local schools to support the uptake of AAC interventions in routine classroom settings. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23699757.
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Affiliation(s)
- Emily D Quinn
- Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University, Portland
| | - Kim Kurin
- Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University, Portland
| | - Kristi L Atkins
- Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University, Portland
| | - Alexandria Cook
- Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University, Portland
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Christopulos TT, Redmond SM. Factors Impacting Implementation of Universal Screening of Developmental Language Disorder in Public Schools. Lang Speech Hear Serv Sch 2023; 54:1080-1102. [PMID: 37459613 DOI: 10.1044/2023_lshss-22-00169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
PURPOSE Developmental language disorder (DLD) is an underidentified neurodevelopmental disorder that affects, on average, one out of 11 kindergarten-age children (ages 4-6 years). Children with DLD can face academic, behavioral, psychiatric, emotional, and social challenges. Universal screening is seen as an effective way for public school districts to increase DLD identification rates. However, little is known about factors impacting implementation of school-based universal screenings for DLD. We partnered with a large suburban school district in the Intermountain West region of the United States to gather detailed perspectives from school personnel regarding the barriers and facilitators to the implementation of universal screening in their district. METHOD Using a two-phase mixed-methods design, we first conducted focus groups to identify potential barriers and facilitators to universal screening. We then used the qualitative data from the first phase to develop a 20-item survey to assess agreement with the focus group results among a wider group of district speech-language pathologists and kindergarten teachers from the school district. RESULTS Our survey showed moderate levels of agreement with our focus group results. In particular, school personnel showed high levels of support for universal screening for DLD, with interesting interplay across various factors: (a) the negative impact of unmanageable workload on personnel under both referral- and universal-based identification formats, (b) the preference for paraprofessionals to administer screenings, (c) the role that Response to Intervention programs may play in offsetting workloads associated with universal screenings, and (d) the need for increased awareness and education about child language development and impairment among general education teachers and the public. CONCLUSION Recommendations for incorporating these factors into more useful and applicable collaborative research-based efforts are presented. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23661876.
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Affiliation(s)
- Tyler T Christopulos
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
| | - Sean M Redmond
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
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Quinn ED, Atkins K, Cook A. Exploring Classroom Factors and Augmentative and Alternative Communication Use in Qualitative Interviews. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2158-2177. [PMID: 37490634 DOI: 10.1044/2023_ajslp-23-00041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
PURPOSE This qualitative study explores classroom contextual factors influencing augmentative and alternative communication (AAC) use in early childhood classrooms. METHOD Semistructured interviews were conducted with six special education teachers, 13 speech-language pathologists (SLPs), and one SLP assistant. Interviews were analyzed inductively in a systematic, multistep coding process using the constant comparative method with member checking. RESULTS Seven themes were identified that affected AAC use in the classroom. Each theme was organized into three categories: individual-, classroom-, or school-level factors. Three themes were categorized as individual-level factors: Students' AAC systems are unavailable, professionals face challenges obtaining AAC knowledge and skills, and students' disruptive behaviors reduce access to AAC. One theme was a classroom-level factor: Classroom demands prevent AAC use. Finally, three themes were considered school-level factors: The culture of AAC influences AAC acceptance, team collaboration is essential for successful implementation, and teams need administrative support to deliver AAC interventions effectively. Conclusions: Teachers and SLPs felt that collaborative teams with AAC expertise, a school culture that endorsed AAC, and solid administrative support accelerated AAC adoption by normalizing AAC use in the classroom. Due to classroom demands, they struggled to use strategies such as aided AAC modeling and responsiveness during group instruction. Finally, participants emphasized that while it was necessary to customize AAC systems for each student, this individualization makes it harder for staff to learn each system and integrate them into classroom activities. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23681718.
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Affiliation(s)
- Emily D Quinn
- Department of Pediatrics, Institute on Development and Disability, Oregon Health and Science University, Portland
| | - Kristi Atkins
- Department of Pediatrics, Institute on Development and Disability, Oregon Health and Science University, Portland
| | - Alexandria Cook
- Department of Pediatrics, Institute on Development and Disability, Oregon Health and Science University, Portland
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Douglas N, Hinckley J, Grandbois K, Schliep M, Wonkka A, Oshita J, Feuerstein J. How a Power Differential Between Clinicians and Researchers Contributes to the Research-to-Practice Gap. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:803-810. [PMID: 36763851 DOI: 10.1044/2022_ajslp-22-00207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE The purpose of this article is to contend that there is a power differential between researchers and clinicians where researchers are the primary creators of knowledge and clinicians are the primary consumers of knowledge. Rooted in a sociological model illustrating interacting levels of power at macro-, meso-, and microlevels, we argue that authentic research-practice partnerships and clinician-researcher collaborations can mitigate this power differential. CONCLUSIONS Clinicians and researchers in our field have vastly different responsibilities and priorities that impact our ability to work collaboratively to solve the most pressing problems for the clients we serve. Although some current research practices may reinforce a power differential causing clinicians to feel less than and to only consume knowledge, there are examples of successful collaborations where this power differential is mitigated. These examples can contribute meaningfully to the dialogue on research-practice partnerships, with the goal of improving outcomes for the clients we serve.
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Affiliation(s)
- Natalie Douglas
- Department of Communication Sciences and Disorders, Central Michigan University, Mt. Pleasant
| | - Jacqueline Hinckley
- Department of Speech-Language Pathology, Nova Southeastern University, Fort Lauderdale, FL
| | - Kate Grandbois
- Grandbois Therapy and Consulting, LLC dba SLP Nerdcast, Concord, MA
| | - Megan Schliep
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Amy Wonkka
- Grandbois Therapy and Consulting, LLC dba SLP Nerdcast, Concord, MA
| | - Jennifer Oshita
- Clinical and Translational Sciences Program, Larner College of Medicine, University of Vermont, Burlington
| | - Julie Feuerstein
- School of Communication Sciences and Disorders, University of Central Florida, Orlando
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Komesidou R, Feller MJ, Wolter JA, Ricketts J, Rasner MG, Putman CA, Hogan TP. Educators' Perceptions of Barriers and Facilitators to the Implementation of Screeners for Developmental Language Disorder and Dyslexia. JOURNAL OF RESEARCH IN READING 2022; 45:277-298. [PMID: 36250042 PMCID: PMC9562997 DOI: 10.1111/1467-9817.12381] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Developmental language disorder (DLD) and dyslexia are common but under-identified conditions that affect children's ability to read and comprehend text. Universal screening is a promising solution for improving under-identification of DLD and dyslexia, however, we lack evidence for how to effectively implement and sustain screening procedures in schools. In the current study, we solicited input from educators in the U.S. around perceived barriers and facilitators to the implementation of researcher-developed screeners for DLD and dyslexia. Using thematic analysis, we identified barriers and facilitators within five domains: (1) features of the screeners, (2) preparation for screening procedures, (3) administration of the screeners, (4) demands on users, and (5) screening results. We discuss these findings and ways we can continue improving our efforts to maximize the contextual fit and utility of screening practices in schools.
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Affiliation(s)
- Rouzana Komesidou
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions
| | - Melissa J. Feller
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions
| | - Julie A. Wolter
- School of Speech, Language, Hearing, and Occupational Sciences, University of Montana
| | - Jessie Ricketts
- Department of Psychology, Royal Holloway, University of London
| | - Mary G. Rasner
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions
| | - Coille A. Putman
- School of Speech, Language, Hearing, and Occupational Sciences, University of Montana
| | - Tiffany P. Hogan
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions
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Davidson MM, Morris MA. Epilogue: Implementation Science in CSD and Starting Where You Are. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1179-1187. [PMID: 35349780 DOI: 10.1044/2022_ajslp-22-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In this epilogue for the Clinicians and Researchers Navigating Implementation Science in CSD forum, we begin by summarizing the eight articles in this forum that describe where the field is in terms of published implementation science (IS) articles in communication sciences and disorders (CSD) and how numerous teams have begun incorporating IS into their research programs. We then situate these articles across three themes: (1) levels of analysis and support; (2) research methods, frameworks, and models; and (3) underserved populations. Next, we consider the challenges and opportunities for conducting IS in CSD. Finally, we conclude by offering tangible steps for researchers, department heads, clinicians, patients, organizations/administrators, and funders in doing and supporting IS research in CSD.
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Davidson MM, Alonzo CN, Barton-Hulsey A, Binger C, Bridges M, Caron J, Douglas NF, Feuerstein JL, Olswang L, Oshita JY, Schliep ME, Quinn E, Morris MA. Prologue: Implementation Science in CSD and Starting Where You Are. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1023-1025. [PMID: 35344451 PMCID: PMC10721237 DOI: 10.1044/2022_ajslp-22-00009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
In this prologue, we introduce readers to the Forum: Clinicians and Researchers Navigating Implementation Science in CSD. Implementation science (IS), or the study of the adoption of evidence-based practice in real-world settings, is a key area of development in communication sciences and disorders (CSD). The goal of this forum was to show by example how researchers and clinicians are collaborating to begin to apply IS in CSD. This goal culminated in a scoping review of IS in CSD, a tutorial on incorporating IS into clinical practice research, three articles on stakeholder engagement, and three examples of IS studies in CSD included in this forum. We hope this forum helps clinicians and researchers to begin wherever they are in their knowledge and understanding of IS in CSD.
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Affiliation(s)
| | | | | | | | - Mindy Bridges
- The University of Kansas Medical Center, Kansas City
| | | | | | | | | | | | | | - Emily Quinn
- Oregon Health & Science University, Portland
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