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This study assessed implementation of the Computer-based Instrument for Low-motor Language Testing (C-BiLLT). The C-BiLLT is an accessible language comprehension assessment tool originally developed for children with cerebral palsy and complex communication needs. The purpose of the current study was to understand the clinical contexts in which the C-BiLLT is used in the Netherlands, Belgium, and Norway and assess barriers and facilitators to implementation. An online survey was distributed to rehabilitation clinicians working in the Netherlands, Dutch-speaking parts of Belgium, and Norway. A total of 90 clinicians reported their training in and use of the C-BiLLT; assessed its acceptability, appropriateness, and feasibility; and commented on perceived barriers as well as advantages of the tool. Acceptability, appropriateness, and feasibility were all rated highly. The C-BiLLT was used with various populations and age groups but most often with children who were younger than 12 years of age, and those with cerebral palsy. The main implementation facilitator was clinicians' motivation; the main barriers were related to resources and complexity of cases. Findings suggest implementation of new assessment tools is an ongoing process that should be monitored following initial training, in order to understand clinical contexts in which the tools are being used.

The Focus on the Outcomes of Communication Under Six (FOCUS) is one of a few validated outcome measures related to children's communicative participation. Additional validation of the FOCUS measure could address the paucity of validated outcomes-based measures available for assessing preschool-age children, particularly for those who are multilingual. The data collected for this study, with a representative sample of Jamaican Creole-English speaking children, extend the applicability of the FOCUS to a broader range of preschoolers and expand psychometric evidence for the FOCUS to a multilingual and understudied context.

Background: There has been a significant uptake in the use of telepractice during the coronavirus SARS-CoV-2 (COVID-19) pandemic. This study explored the experiences of speech and language therapists (SLTs), assistants (SLTAs) and parents with telepractice during the COVID-19 pandemic. Aims: (1) To identify factors that influenced success of telepractice; and (2) to describe clinicians' and parents' preferences for the future mode of service delivery for preschoolers with communication disorders. Methods & Procedures: The study was conducted in partnership with one publicly funded programme in Ontario, Canada, that offered services to preschoolers with speech, language and communication needs at no cost. SLTs (N = 13), assistants (N = 3) and parents (N = 13) shared their experiences and perspectives during semi-structured videoconference interviews. Outcomes & Results: Factors that influenced the success of telepractice were reported in three categories: the setting (i.e., where and how telepractice was being delivered); the nature of telepractice (i.e., the services that were provided via telepractice); and the individuals (i.e., who was involved in telepractice). These factors were reported to interact with each other. As the needs for each child and family are unique, parents and clinicians reported a preference for a hybrid and flexible service delivery model in the future. Conclusions & Implications: The themes identified in this study can be used by clinicians and managers to consider factors that influence the success of telepractice for children and families.

Background: Speech-language pathology services are among the most frequently accessed services for young autistic children. Therefore, understanding the nature of these services, what challenges these clinicians face, and what supports they value is critical for developing appropriate policies and practices that can maximize positive outcomes for children and families. This study had two primary aims. The first was to examine the self-reported assessment and intervention practices of community-based Speech Language Pathologists (SLPs) and communicative disorders assistants (CDAs; who provide services under the supervision of a SLP) in supporting preschool children with suspected and diagnosed autism. The second aim was to identify barriers and supports (facilitators) to providing services in the community using the Consolidated Framework for Implementation Research (CFIR) as a framework. Methods: A cross-sectional online survey was used to collect qualitative and quantitative data from clinicians in Ontario Canada who were providing speech and language services to preschool children with suspected or diagnosed autism. Quantitative data were used to describe clinicians" practices, and qualitative data captured their perspectives on barriers and supports to providing services. Results: A total of 258 clinicians participated in the survey. On average, clinicians reported almost half of the preschoolers on their caseload had either diagnosed or suspected autism. There was consistency across the skill development areas assessed by SLPs, and targeted during therapy sessions, with the top four areas targeted being: foundational social communication, language, play and pragmatics. However, there was wide variation in speech and language assessment and intervention practices reported by this sample of clinicians (i.e., service delivery models, tools or programs used, length and duration of therapy services, level of collaboration with other professionals). Clinicians identified several barriers to providing services: limited funding and time, lack of inter-professional collaboration, difficulty accessing services, community messaging about autism services, family readiness and clinician knowledge. Supports (facilitators) included: access to autism-focused professional development, inter- and intra-professional collaboration, and access to additional supports in the community.

Background: The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) is an international initiative that offers standardized and validated tools to guide the appraisal of patient-reported outcome measures in healthcare. Aims: To explore the use of a new set of tools from the COSMIN to appraise studies on one outcome measure available to speech and language therapists (SLTs). Methods & Procedures: We used the COSMIN tools to appraise seven studies and a user manual that reported the measurement properties of the Focus on the Outcomes of Children Under Six (FOCUS), a validated measure of pre-schoolers' communicative participation that is used in various contexts around the world. Outcomes & Results: Using COSMIN guidelines, the FOCUS was categorized as a 'category A' tool because there was a sufficient level of evidence to support its content validity and internal consistency. According to the COSMIN guidelines, this means that the FOCUS can be recommended for use. The quality of evidence supporting measurement properties of the FOCUS received a rating of 'moderate', meaning users can have moderate confidence in its measurement properties. Since these ratings from the COSMIN tools may be unclear to users of the FOCUS, we have provided more specific recommendations. Conclusions & Implications: The COSMIN tools offer detailed standards to support the appraisal of outcome measures available to SLTs. However, several limitations were observed, and recommendations to support the application of the COSMIN tools are provided.

This study explored participation- and impairment-based outcomes for 24 late-to-talk toddlers (M age = 20.46 months, SD = 3.09, 62.5% male) whose parents participated in Target Word™, The Hanen Program® for Parents of Children who are Late Talkers in community clinics across Ontario. Parents completed the MacArthur-Bates Communicative Development Inventories (MBCDI), The Focus on the Outcomes of Communication Under Six (FOCUS-34), and a speech sound checklist: (1) prior to starting the program, (2) at the end of direct intervention, and (3) after a consolidation period. Speech-language pathologists classified children's communicative function using the Communication Function Classification System (CFCS) at all assessment points and provided FOCUS scores from an initial assessment. No change was recorded in CFCS levels between initial assessment and start of the program, but many children moved to a more advanced level by the end of the program (n = 12) or consolidation period (n = 19). Significant changes in children's communicative participation skills (FOCUS) were found between initial assessment and the start of the program, and during the 12-week direct intervention (75% made clinically meaningful change). Significant growth in expressive vocabulary and consonant inventory occurred during direct intervention. Correlations between change on impairment- and participation-based measures were not significant. The Target Word program appears to improve communicative function for late-to-talk preschoolers. Children also made gains in communicative participation skills, expressive vocabulary, and consonant inventory during the program, but further research is needed to determine the effectiveness of Target Word in these areas.

Purpose: The purpose of this study was to characterize the communicative participation and functional speech intelligibility (i.e., how children use communication and how well they are understood across everyday life) of typically developing (TD) bilingual Jamaican preschoolers and those with functionally defined speech sound disorders (fSSDs) in the COVID-19 milieu. Findings were also compared to an existing corpus of baseline data to document and explore differences in children's speech-language outcomes secondary to pandemic-related social restrictions. Method: Thirty bilingual Jamaican preschoolers, 21 TD and nine with fSSDs, were assessed during the pandemic via telepractice. Association and univariate mean testing were completed to characterize children's communicative participation and functional speech intelligibility. Data were then compared to an existing corpus of baseline data (collected in person between 2013 and 2019), which included direct child assessment and parent reports and consisted of TD (n = 226) Jamaican Creole-English--speaking preschoolers and those with fSSDs (n = 39) to compare performance profiles across data sets. All participants attended schools in Kingston, Jamaica. Results: Measures of communicative participation remained stable in the context of the COVID-19 milieu for children in the TD and fSSD groups, but functional speech intelligibility outcomes for children with fSSDs deviated between in-person findings collected from children pre-pandemic. Between-groups differences were also found on measures of speech production accuracy but were no longer significant when considering telepractice as a covariate. Conclusions: Findings from this investigation serve to characterize the communicative participation and functional speech intelligibility of TD bilingual Jamaican preschoolers and those with fSSDs in the COVID-19 milieu. By extension, the results comparing data from preschoolers collected during the pandemic to an existing corpus of baseline data from a different group of preschoolers provide critical insights about multilingual children's speech-language outcomes in the context of acutely changing environmental circumstances. [ABSTRACT FROM AUTHOR]

Background and aims: Caregiver-delivered programs are a recommended best practice to support young autistic children. While research has extensively explored children's outcomes quantitatively, minimal qualitative research has been conducted to understand caregivers' perspectives of program outcomes for themselves and their children. Hearing directly from caregivers is an important step in ensuring these programs are meeting the needs of those who use them. This study explored caregivers' perceived outcomes following one virtual caregiver-delivered program, The Hanen Centre's More Than Words® (MTW) program. Methods: This study was a secondary analysis of data from individual interviews conducted with 21 caregivers who had recently participated in a virtual MTW program. A hybrid codebook thematic analysis approach was taken to analyze the interview data. Program outcomes were coded and analyzed within the International Classification Functioning, Disability, and Health (ICF) framework. Additionally, caregivers completed an online survey and rated Likert Scale items about perceived program outcomes, which were analyzed descriptively. Results: Five themes were identified: (1) caregivers learned new strategies to facilitate their child's development, (2) caregivers developed a new mindset, (3) children gained functional communication skills, (4) caregiver–child relationships improved, and (5) caregivers gained a social and professional support network. These themes fell within four of five ICF framework components (activities, participation, personal factors, and environmental factors). No themes were identified under Body Structures and Functions. Survey results indicated most caregivers reported learning new communication strategies (n = 20, 95%), and identifying new teaching opportunities with their child (n = 21, 100%). Conclusions: Some reported outcomes, related to Activities and Participation, were consistent with previous reports in the literature on the MTW program. In line with previous research, caregivers learned strategies to support their child's communication development. Contrary to previous quantitative studies, caregivers in this study rarely commented on gains in vocabulary and instead focused on gains in skills that positively impacted their child's ability to engage in meaningful social interaction. Novel outcomes were identified within the Participation, Personal Factors, and Environmental Factors components of the ICF framework. Implications: Caregivers in this study identified important outcomes for themselves and their child that have not been the focus of prior research, suggesting it is important to integrate their perspectives in the development and evaluation of caregiver-delivered programs. Clinicians should include goals that address outcomes identified as important by caregivers, including those that address children's Participation, and those that target caregivers' Personal and Environmental Factors. Developers of caregiver-delivered programs could integrate identified goals to ensure they are meeting families' needs. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this scoping review was to identify current measures used to evaluate speech-language outcomes for preschoolers with communication disorders within the framework of the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY; World Health Organization, 2007). Method: The review involved 5 phases outlined by Arksey and O'Malley (2005) and further developed by Levac, Colquhoun, and O'Brien (2010): (a) articulating the research question; (b) identifying relevant studies; (c) selecting studies; (d) charting the data; and (e) collating, summarizing, and reporting the results. The ICF-CY was used to frame the measures included. Results: A total of 214 relevant peer-reviewed publications were included in the review. Most publications used measures to evaluate changes in outcomes for Activities (65%), followed by measures evaluating changes in Body Functions (20%), and finally measures evaluating changes at the level of Participation (15%). There has been a slight increase in the evaluation of Participation-based outcomes in the past 4 years (2012-2015). Conclusion: The review revealed a dearth of measures in the pediatric speech-language literature that address Participation-based outcomes. The authors strongly advocate for the use of Participation-based outcome measures to detect meaningful change in the lives of children and families.

This brief report presents interrater reliability data for the Focus on the Outcomes of Communication Under Six (FOCUS-34) between parents, and between parents and speech-language pathologists (SLPs). Reliability for all three raters combined was good to excellent across three assessments. Reliability for pairs of raters was variable but generally good. [ABSTRACT FROM AUTHOR]

To summarize the available evidence for the delivery of synchronous virtual rehabilitation intervention services for preschoolers and to identify key factors associated with virtual intervention. Five databases were searched to identify peer-reviewed articles that assessed virtual interventions for preschoolers delivered by rehabilitation health professionals including physical therapists, occupational therapists, speech-language pathologists, audiologists, and their associated assistants. Relevant data regarding demographics, technology, mode of service delivery, timing, engagement, and measurement data were extracted, and charted. Data were then summarized quantitatively using frequency counts, and qualitatively using descriptive summaries. Sixteen studies were identified. Virtual interventions primarily targeted language difficulties or disorders, therefore most services were delivered by a speech-language pathologist or audiologist. Most interventions were delivered using Skype or Zoom on a weekly basis. Various technological features (e.g., phonology software, 'e-helpers') were included, and multiple activities (e.g., playdough, bubbles) and strategies were used to support engagement. This scoping review provides current knowledge about the delivery of virtual rehabilitation interventions for preschoolers to help guide best practices for clinicians. Future research could assess the validity of existing outcome measures in the virtual environment, and outline optimal session length and frequency for virtual preschool interventions. The COVID-19 pandemic has increased the need for effective, evidence-based virtual interventions. This study summarizes the available literature to support preschool rehabilitation clinicians in making decisions about virtual interventions. Data presented can inform clinical decisions about technology to use, session length and frequency for various disorders, and activities used to engage preschoolers in the virtual environment. [ABSTRACT FROM AUTHOR]

Aim: To describe uses of the Focus on the Outcomes of Communication Under Six (FOCUS) in research with children with and without various communication disorders since its publication in 2010. Method: Six databases were searched for the term 'Focus on the Outcomes of Communication Under Six'. With additional searches we ascertained 70 articles, of which 25 met inclusion criteria for full review and data extraction. Results: The FOCUS has been used in research across multiple countries, purposes, populations, contexts, and versions. Evaluative studies have described: the development of children's communicative participation skills and factors that impact the development of communicative participation; the impact of specific interventions on communicative participation; how FOCUS captures change relative to measures of impairment; and how FOCUS performs when used at different intervals. Adaptations have included: use of the FOCUS as a descriptive or discriminative tool; use with children outside the validated age range; use of select items; and use with typically developing children. Interpretation: The FOCUS is used worldwide in research and practice, and much has been learned about children's communicative participation. Future research is needed to explore the relationship between children's impairments and their communicative participation, develop a FOCUS App, and develop and validate a FOCUS for school‐age children. [ABSTRACT FROM AUTHOR]

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. 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. [ABSTRACT FROM AUTHOR]

Purpose: In this paper, we present our experiences - both successes and challenges - in implementing evidence-based classification tools into clinical practice. We also make recommendations for others wanting to promote the uptake and application of new research-based assessment tools. Method: We first describe classification systems and the benefits of using them in both research and practice. We then present a theoretical framework from Implementation Science to report strategies we have used to implement two research-based classification tools into practice. We also illustrate some of the challenges we have encountered by reporting results from an online survey investigating 58 Speechlanguage Pathologists' knowledge and use of the Communication Function Classification System (CFCS), a new tool to classify children's functional communication skills. Result and Conclusions: We offer recommendations for researchers wanting to promote the uptake of new tools in clinical practice. Specifically, we identify structural, organizational, innovation, practitioner, and patient-related factors that we recommend researchers address in the design of implementation interventions. Roles and responsibilities of both researchers and clinicians in making implementations science a success are presented. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to identify predictors of communicative participation outcomes for a large cohort of preschoolers with speech and language impairments. Method: A secondary analysis of longitudinal program evaluation data from Ontario, Canada's Preschool Speech and Language Program was done. Data available for 46,872 children 18-67 months of age (M = 41.76 months, SD = 11.92; 68% boys, 32% girls) were previously used to predict children's communicative participation skill development in 5 levels of function. Demographic and intervention-based variables were added to the models to identify new predictors of growth. Results: Three demographic and 3 intervention-based variables were statistically significant predictors of children's communicative participation outcomes. Clinically significant predictors included participation in an early learning environment, receipt of speech-language interventions and the amount of time spent in intervention. These variables impacted predicted outcomes differently, depending on a child's level of communicative function. Conclusions: This population-based study of preschoolers with speech and language impairments identified predictors of growth in communicative participation skills-an outcome important and meaningful to families but not often explored. A broad picture emerged of factors that may influence the development of communicative participation skills and may be used to predict outcomes for preschoolers. Given the large sample size, these robust findings may be used to predict outcomes outside the Preschool Speech and Language Program as well. [ABSTRACT FROM AUTHOR]

Purpose: We developed a Knowledge Translation (KT) intervention to standardize the way speech-language pathologists working in Ontario Canada’s Preschool Speech and Language Program (PSLP) used the Communication Function Classification System (CFCS). This tool was being used as part of a provincial program evaluation and standardizing its use was critical for establishing reliability and validity within the provincial dataset.Method: Two theoretical foundations – Diffusion of Innovations and the Communication Persuasion Matrix – were used to develop and disseminate the intervention to standardize use of the CFCS among a cohort speech-language pathologists. A descriptive pre-test/post-test study was used to evaluate the intervention. Fifty-two participants completed an electronic pre-test survey, reviewed intervention materials online, and then immediately completed an electronic post-test survey.Results: The intervention improved clinicians’ understanding of how the CFCS should be used, their intentions to use the tool in the standardized way, and their abilities to make correct classifications using the tool.Conclusions: Findings from this work will be shared with representatives of the Ontario PSLP. The intervention may be disseminated to all speech-language pathologists working in the program. This study can be used as a model for developing and disseminating KT interventions for clinicians in paediatric rehabilitation.Implications for RehabilitationThe Communication Function Classification System (CFCS) is a new tool that allows speech-language pathologists to classify children’s skills into five meaningful levels of function.There is uncertainty and inconsistent practice in the field about the methods for using this tool.This study used combined two theoretical frameworks to develop an intervention to standardize use of the CFCS among a cohort of speech-language pathologists.The intervention effectively increased clinicians’ understanding of the methods for using the CFCS, ability to make correct classifications, and intention to use the tool in the standardized way in the future. [ABSTRACT FROM AUTHOR]