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.

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.

Education for students with neurodevelopmental disabilities-Resources and educational adjustments

Children with neurodevelopmental disorders are more likely to face challenges of various kinds throughout their schooling due to their vulnerability factors. Although certain evidence-based practices have been recognized to be effective in supporting academic performance or social and personal adjustment, transferring these practices to school realities remains a challenge. Indeed, the educational trend favored for more than 20 years promotes the development of all students in the most natural context possible. The objective of this chapter is to shed light on how resources and EBPs can be organized in an inclusive education context. A tiered framework, commonly adopted as different models across the world, is presented and used to demonstrate how interventions can be prioritized for the difficulties and special needs of specific (e.g., ADHD, dyslexia, and developmental coordination disorder) and complex (e.g., autism spectrum disorder) neurodevelopmental disorders. The chapter ends with a discussion of the conditions and drivers of intervention fidelity and effectiveness in an inclusive context and, more specifically, support for teachers and parents.

Inclusion and equity in education: Current policy reform in Nova Scotia, Canada

This article aims to explore the context of inclusive education policy in Canada, and to highlight the particular case of inclusive education policy reform in the province of Nova Scotia. As with most other provinces and territories, inclusive education policy in Nova Scotia has broadened to include a lens of equity, with a focus on not only students with special education needs, but all students – particularly those most often marginalized by and within Canadian school systems. The article reflects on the first phase of the developmental evaluation process which took place prior to full implementation of the policy. Four interconnected key themes emerge: 1) the shifting roles and identities for educators and specialized staff; 2) the changing roles of classroom teachers; 3) the importance of support to ensure effective universal and differentiated classroom practices; and 4) the professional learning of school staff. Although situated within the Nova Scotian and the national Canadian context, the discussion and implications can readily be applied to international systems engaged in developing and implementing broad inclusive education policy.

The Marriage of Policy, Practices, and Data to Achieve Educational Reform

The policy decisions of state, district and school educators affect the extent to which students have access to high-quality practices. This is especially relevant for students with disabilities and their families. This article summarizes a presentation made at the 2019 AAIDD conference and proposes an operational role for policy makers. Two frequently cited advances in education are (a) the commitment to adopt "evidence-based practices," and (b) the impact of information technology and data systems on the active "use of data for decision making" in schools. This article reviews the integrative role that policy decisions make in transforming effective practices and good data systems into practical outcomes for children and families.

Autism spectrum disorder: How can occupational therapists support schools?

Background.

Children with autism spectrum disorder (ASD) face multiple occupational challenges in their school, and school staff need additional support to increase their participation.

Purpose.

The aim of this study is to identify how Response to Intervention (RTI) could be used by occupational therapists to support school personnel who work with children with ASD.

Method.

In a descriptive qualitative study, three discussion groups were undertaken with occupational therapists and school staff members in Quebec, Canada, to identify the main concerns regarding the participation of children with ASD in school activities as well as the actions to consider when attempting to increase school-related abilities.

Findings.

School staff members are primarily concerned with frequent outbursts and limited autonomy, along with low motivation and anxiety in children with ASD in diverse school activities and contexts. The actions identified provide guidelines for school and occupational therapist selection, the process to follow, collaborative practices, and support required.

Implications.

A practice model is presented for occupational therapists who seek to develop school capacity to support the participation of children with ASD.

Evolving Nature of School Psychology in Alberta

Over the past 15 years, the practice of school psychology in the province of Alberta reflects the entrenchment of assessment with the emerging possibility of a broader service provider role. This article articulates the influence that politics and government has had on the role of school psychologists in Alberta schools as special education funding frameworks have evolved. The authors describe the present training and roles of Alberta school psychologists and outline the work that has been undertaken in that province to advocate for a role in key government initiatives of Response to Intervention (RTI) and Inclusive Education.

Best practice principles for management of children with developmental coordination disorder (DCD): results of a scoping review

BACKGROUND

Developmental coordination disorder (DCD) is a prevalent health condition that is frequently unrecognized despite the substantial evidence that has accumulated regarding how it affects children's health, education and skills. Most literature focuses on measurement of impairment and description of intervention approaches for individual children; little is known about the principles that should guide best practice and service delivery for children with DCD as a population. The purpose of this study was to identify these principles.

METHODS

A scoping review was used to 'map' the information available to inform intervention and service delivery. Scholarly and grey literature written in English was identified in six databases, using a combination of keywords (e.g. guidelines, management, models and DCD); a 'snow-balling' technique was also used in Canada and the UK to access clinical protocols used in publicly funded health care systems. Over 500 documents were screened: 31 met inclusion criteria as they outlined practice principles for children with DCD as a population. Data regarding best practices were independently extracted by two reviewers and then compared with achieve consistency and consensus.

RESULTS

Two over-arching themes emerged, with five principles: (1) Organizing services to efficiently meet the comprehensive needs of children (e.g. Increasing awareness of DCD and coordination; Implementing clearly defined pathways; Using a graduated/staged approach); (2) Working collaboratively to offer evidence-based services (e.g. Integration of child and family views; Evidence-based interventions fostering function, participation and prevention).

CONCLUSION

Numerous documents support each of the principles, reflecting agreement across studies about recommended organization of services. While these principles may apply to many populations of children with disabilities, this review highlights how essential these principles are in DCD. Researchers, managers, clinicians, community partners and families are encouraged to work together in designing, implementing and evaluating interventions that reflect these principles.

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.