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Purpose: This quality improvement project aimed to address the inconsistent use of clinical labels across a preschool speech and language program in Ontario, Canada. The study investigated whether a multicomponent knowledge translation (KT) intervention could increase speech-language pathologists’ (SLPs’) knowledge about the recommended clinical labels, motivate their intentions to use the labels, and facilitate practice change during a 3-month pilot period. Method: The diffusion of innovations theory was utilized to identify and address known and suspected barriers and facilitators that could influence the adoption of consistent terminology. The intervention was evaluated using a pre-experimental study design (with pre, post, and follow-up testing) and included two phases: Phase 1 involved the pretraining survey, KT intervention, and post-training survey, and Phase 2 included an exit survey after a 3-month pilot period. Results: Five hundred twenty-nine SLPs in Phase 1 and 387 SLPs in Phase 2 participated. Following the web-based intervention, SLPs demonstrated improved knowledge about the recommended labels with most indicating intentions to communicate the labels going forward. SLPs also reported increased comfort using labels and positive views on their importance and value. After the 3-month pilot period, SLPs’ reported use of most recommended labels decreased, as did ratings of comfort, value, and importance. However, most SLPs reported intentions to use the labels going forward. Conclusions: Despite having intentions to adopt the recommended labels, the lack of implementation by SLPs suggests the presence of additional barriers impacting their use of the recommended clinical labels in practice. Future work should investigate clinician-identified barriers to inform future implementation efforts. [ABSTRACT FROM AUTHOR]

Purpose: Despite the speed with which telehealth use advanced during the COVID-19 pandemic, evidence is needed to support the remote delivery of standardized assessments. This study investigated the reliability and feasibility of administering a standardized language assessment administered in real-world telehealth scenarios compared to in-person administration. Method: A total of 100 children between the ages of 3 and 12 years were administered one of three versions of the Clinical Evaluation of Language Fundamentals (CELF). Children were administered the CELF by the same licensed speech-language pathologists (SLPs) in person and using telehealth, with the order counterbalanced. Means for Core Language standard scores were compared between conditions and among devices. Descriptive statistics summarized the behavior and technology disruptions during administration as well as the results of parent and SLP telehealth perception surveys. Results: In-person and telehealth mean scores on all three versions of the CELF revealed no systematic differences of one condition under- or overestimating another. The incidence of child behavior disruptions was similar for both test administration conditions. Adaptations compensated for the rare technology disruptions. Despite no significant language score and behavior differences between testing conditions, parents reported they continued to prefer in-person assessments. SLP participants viewed telehealth overall positively but identified conditions in which they continued to prefer in-person delivery. Conclusions: This study provides evidence of minimal or no differences in scores and behavioral or technological disruptions between remote and inperson administration of the CELF core language assessments. SLP and parent participants’ attitudes toward remote delivery of standardized tests appear to be evolving in a positive direction compared to previous studies. [ABSTRACT FROM AUTHOR]

Purpose: Family--professional partnerships are important for youth learning to use aided augmentative and alternative communication (AAC). This study examined the family-oriented beliefs and practices of speech-language pathologists (SLPs) working with preschool and school-aged children learning to use aided AAC (aged 3--21 years), specifically during the COVID-19 pandemic. Method: Participants were 25 SLPs who participated in an individual semistructured interview. Qualitative analysis was used to identify and describe groups of SLPs based on commonalities and differences in their beliefs and practices working with families. The characteristics of SLPs in each group was also explored descriptively (e.g., race/ethnicity, work setting, caseload). Results: SLPs clustered into three groups based on their beliefs and practices: (a) professionally centered, (b) family-allied, and (c) family-focused. SLPs varied across these groups in how they planned services, offered training/coaching, communicated, shared resources, offered emotional support, and adapted to and with different families. Conclusions: Findings indicate the need to support greater family-centeredness in AAC services by building on the strengths of SLPs in the field. Promoting strong family--professional partnerships could in turn improve outcomes for students who use AAC. [ABSTRACT FROM AUTHOR]

Background: Cognitive fatigue after childhood acquired brain injury (ABI) is known to negatively impact engagement in typical academic and social activities, yet limited evidence is available to inform speech-language pathologists' (SLPs') clinical practices. The purpose of this research study was to explore stakeholders' perspectives on cognitive fatigue for children with ABI to inform future directions for clinicians and researchers. Method: Twelve parents of children with traumatic brain injury and 35 SLPs participated in an online survey with 33 and 49 questions, respectively, including participant characteristics and perspectives on cognitive fatigue. Results: Parents reported being between "somewhat" and "highly aware" about cognitive fatigue, whereas SLPs reported being between "neither aware or not aware" and "somewhat aware." Parents reported being between "somewhat comfortable" and "very comfortable," whereas SLPs reported being between "neither comfortable or uncomfortable" and "somewhat comfortable" addressing cognitive fatigue in children with ABI. SLPs "somewhat" to "strongly" agreed that cognitive fatigue for children with ABI was within their scope of practice. Parents and SLPs reported accommodations and strategies useful to managing cognitive fatigue in children with brain injury, as well as factors that worsen and lessen cognitive fatigue. Conclusions: While additional foundational and translation research is needed, the perspectives of parents and SLPs begin to address a critical gap in SLPs' assessment and management of cognitive fatigue in children with ABI. [ABSTRACT FROM AUTHOR]

Purpose: This study had two aims. Aim 1 was to query both communication science and disorders (CSD) faculty and school-based speech-language pathologists (SLPs) regarding how written language is/was covered in their graduate programs. Aim 2 was to query school-based SLPs about their written language service provision. Method: CSD faculty (n = 143) and school-based SLPs (n = 610) completed an online survey examining (a) if and how written language was addressed in their graduate program, (b) what content related to written language was covered in graduate school, and (c) provision of written language services in schools (SLPs only). Results: There was a discrepancy in reports of training provision. Faculty reported providing more training than SLPs reported receiving. However, SLPs with fewer years of experience reported slightly higher levels of training compared to those with more years of experience. Additionally, there was variability among SLPs in how often they targeted written language in therapy. Finally, receipt of training in written language was a significant predictor of provision of written language services, as reported by SLPs. Conclusions: SLPs play a key role on literacy teams in schools, but many SLPs did not receive adequate training in written language. In order to ensure SLPs are trained to work with children with reading difficulties, graduate programs should ensure that written language is part of the clinical and academic curricula. [ABSTRACT FROM AUTHOR]

Purpose: This research note was motivated by community speech-language pathologists (SLPs) who have expressed concerns about how to interpret the unexpected observation of higher performance on the Digit Span Backward task than the Digit Span Forward task on the Test of Integrated Language and Literacy Skills (TILLS). We therefore conducted an exploratory analysis to examine the pattern of digit span performance in children to help clinicians interpret their findings. Method: We investigated performance on the Digit Span Forward and Digit Span Backward subtests using the TILLS normative sample (N = 1,262). Raw scores, standard scores, and percentile ranks were systematically compared. In addition, we were able to estimate span length (longest number of items that can be accurately recalled) for 69 participants and evaluated the relation between performance and span length. Results: Our exploratory analyses revealed that "better" performance on the backward than forward task was rare. Instead, the pattern that SLPs are reporting can be explained by three factors: (a) a statistical phenomenon exacerbating small differences, (b) comparing standard scores or percentile ranks instead of raw scores or span length, and (c) better backward scores can still mean longer forward span length. Conclusions: It is likely that community SLPs tended to report cases of better backward than forward recall because it is the more remarkable and interesting finding, leading to the perception that the pattern is common, when it is not. Overall, we caution clinicians against overinterpreting their own client's performance on the digit span tests. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: This research was conducted to describe the clinical characteristics of children with a history of opioid exposure as perceived by the speechlanguage pathologists (SLPs) treating them. Method: Three focus groups were conducted. Participants consisted of 20 SLPs working in the schools in West Virginia who had experienced working with children with a confirmed or suspected history of opioid exposure. A thematic, qualitative analysis was conducted, whereby focus group sessions were transcribed verbatim and information was coded, organized into themes, and interpreted. Results: Themes of perceived clinical characteristics (speech, language, executive function, and other developmental delays) are reported to address the research question. Additionally, themes derived from the data regarding perceived significant differentiators (greater severity/needs, inconsistent performance, and atypical manifestation) and perceived confounding characteristics (safety and well-being, aspects of home environment, and effects on school environment) that are often reported in children with a history or suspected history of opioid exposure are presented. Conclusions: Perceived clinical characteristics of this population, both intrinsic and situational, highlight the complex profile of this population and demonstrate the importance of considering each child from a multidimensional perspective. Additional research is needed to represent the profile of these children more completely and to identify successful supports that will improve their speech and language outcomes, educational achievement, and their overall quality of life. [ABSTRACT FROM AUTHOR]

Purpose: This research intended to identify current practices being implemented with children who have a history or suspected history of opioid exposure, as well as challenges faced by speech-language pathologists in the schools. Method: Focus group data from three groups totaling 20 speech-language pathologists (SLPs) working in schools in West Virginia, also used in a previous study, were analyzed using qualitative thematic analysis to better understand SLP service provision to children with a history or suspected history of opioid exposure. Results: Results revealed two primary themes, reported as (a) service delivery in action (current practice trends and challenges) and (b) affective/cognitive manifestations (uncertainty about their role and various emotions expressed) of the SLPs who participated in the focus groups. Conclusions: This study revealed important clinical implications derived from the reports of participants. Particularly, the importance of communication and advocacy in the care of these children and the need to rethink what our scope of practice means when working with this vulnerable population are discussed. [ABSTRACT FROM AUTHOR]

Purpose: COVID-19 caused a worldwide conversion from in-person therapy to telehealth; however, limited evidence to support the efficacy of remotely delivering standardized tests puts the future of widespread telehealth use at risk. The aim of this study is to investigate the reliability of scoring a speech sound assessment administered in real-world scenarios including two examples of telehealth technology. Method: A total of thirty-nine 3- to 8-year-olds were administered the Goldman-Fristoe Test of Articulation-Third Edition. Licensed speech-language pathologists (SLPs) concurrently scored children's responses in person and in two telehealth conditions considered typical and enhanced. Mean standard scores and interrater reliability results were compared among the three conditions. Descriptive statistics were used to summarize the frequency of technology and behavior disruptions during administration and the results of an SLP telehealth perception survey. Results: All scoring conditions were found to be highly correlated, with mean differences revealing no systematic differences of one condition over- or underestimating another. Although response agreement was high (85%-87%), final sounds in words or sounds that are difficult to observe tended to attenuate reliability. Neither child nor technology disruptions affected SLPs' ability to score responses. Despite no significant differences between conditions on scoring reliability, SLP participants reported they continued to prefer in-person over a telehealth speech sound assessment. Conclusions: This study supports the provision of a pediatric speech sound assessment using consumer-grade equipment, as in-person, typical telehealth, and enhanced telehealth scoring conditions produced similar results. However, SLP participants' skeptical attitudes toward remote delivery of standardized tests reveal an ongoing barrier to widespread telehealth use. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the extent to which speech-language pathologists (SLPs) facilitate parents’ completion of homework activities for children with speech sound disorder (SSD). In addition, this study explored factors related to more consistent communication about homework completion and strategies considered particularly effective for supporting this element of parental involvement. Method: Licensed SLPs serving at least one child with SSD were invited to participate in an online survey. Questions relevant to this study gathered information regarding (a) frequency of communication about homework distribution and follow-up, (b) demographic and workplace characteristics, and (c) an open-ended question about the specific strategies used to support parental involvement and completion of homework activities. Results: Descriptive results indicated considerable variability with respect to how frequently SLPs engaged in communication about homework completion, but that school-based SLPs were significantly less likely to engage in this type of follow-up. Strategies considered effective, however, were similar across therapy contexts. Conclusion: These results suggest potentially important differences between school-based services and therapy in other contexts with respect to this particular aspect of service provision for children with SSD. [ABSTRACT FROM AUTHOR]

Purpose: This exploratory study examined speech-language pathologists' (SLPs) clinical experience and work environment characteristics impacting comfort with providing intervention to children with traumatic brain injury (TBI). Method: This study included 162 SLPs who responded to a national survey about their comfort providing intervention to children with TBI, clinical experience (i.e., years of experience treating children with TBI, TBI preprofessional training and professional development, and licensure/credentialing), and work environment (i.e., work setting, caseload size, geographic location). Results: Findings from latent class analysis revealed 3 distinct groups of SLPs based on their comfort with providing services to children with TBI: those with low comfort, moderate comfort, and high comfort. Further analyses revealed statistically significant differences across the 3 groups in the areas of years of experience treating children with TBI, professional development, work setting, TBI caseload size, and geographic location. Conclusions: Our findings reveal that most SLPs feel comfortable providing intervention to children with TBI; however, differences in characteristics across groups suggest that specific steps can be taken to ensure increased comfort for all SLPs working with this population. Practicing SLPs may increase their level of comfort through professional development and hands-on, mentored experience with TBI. Efforts such as these may influence the quality of service provision and expand the population of SLPs who feel comfortable treating children with TBI. Future research is needed to further examine how comfort and SLP characteristics directly impact the quality of speech and language intervention and long-term outcomes of children with TBI. [ABSTRACT FROM AUTHOR]