Speech and Language Therapy: The Decision-Making Process When Working with Children (2nd Edition)


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Rigorously underpinned with current research and revised legislation, this is an important textbook for speech and language therapy students, potential students and specialist teachers in training. Speech and Language Therapy: the decision-making process when working with children will also be relevant to newly qualified therapists, therapists returning to the profession, specialist teachers and Special Educational Needs Coordinators.

Speech and Language Therapy : Myra Kersner, : : Blackwell's

Book Depository. Brand new. Login to see store details. On arrival, surveys were separated from personal identifying information and secured in separate locked filing cabinets or password protected folders. All surveys were anonymized and coded. Data were entered into SPSS on a password protected computer for future reference. Quantitative data were analysed using descriptive statistics. The number of participants using each assessment was determined for each assessment type.

This involved grouping the rationales into basic themes for each published assessment based on the similarity of response.

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The number of participants reporting each rationale was recorded for each assessment. Each author took the rationale data for an equivalent number of assessments to code into basic themes. This allowed identification of the specific rationales for each assessment. To enhance the trustworthiness of this analysis, initial coding was repeated for each assessment, with second coding being conducted independently by one of the other authors. Any coding discrepancies were resolved via discussion. The few comments that were difficult to understand and problematic to code, typically due to being unfinished or unclearly articulated, were excluded from the analysis.

This provided a synthesis of the various rationales across the different assessments. This analysis was also independently checked by the third author, to enhance the credibility and trustworthiness of the findings, with discrepancies once again resolved via discussion. A similar process was undertaken for the content analysis of the unpublished assessments but, due to their individual, idiosyncratic and unpublished nature, only the synthesized rationales are presented in the findings below with frequency and percentages provided relating to the number of participants reporting the theme, rather than the number of assessments that corresponded to particular themes.

Slightly fewer 46; Most of the 55 respondents 42; Typically, multiple methods were used to assess communication with unpublished and published assessments merging into an assessment profile, although this was rarely formally described as such in the surveys. Only five 9. Use of unpublished assessments reportedly involved developing new assessments, but it also involved taking a number of existing assessments, adapting each and merging them into a new assessment, or taking an individual published assessment and adapting it.

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Hence, an eclectic approach to assessment was evident in the work of the SLTs surveyed. The purpose in all cases was to develop, in the opinion of the participant, a more functionally useful assessment. Hence, these tended to be used with either adults or children with few using unpublished assessments with both groups. This contrasts with the published assessments, which were more often used with both adults and children.

First, the potential information that could be gleaned about the person's communicative developmental level informed the selection of 16 Comments were made about assessments being appropriate to the communicative level of people with PIMD because they enabled identification and distinguishing of early communicative developmental stages 7; Second, assessments were selected because they provided information about how the person with PIMD communicated 7; This included identifying specific, personalized communication behaviours used 2; 7. They also helped them to better understand the specific ways people communicated across different contexts 1; 3.

Third, use of particular assessments supported effective working with communication partners, including family and paid carers and teachers 10; Some assessments were described as helpful for explaining communication levels of the person with PIMD to communication partners. This enabled a shared understanding of the person's communicative behaviours to be reached 8; Assessments were also used in training communication partners and in setting joint goals with them 5; Using assessments in this way was described as helping to build more positive relationships between the clinician and these stakeholders 2; 7.

Fourth, 12 The comprehensiveness in detail, breadth and thoroughness of the information assessments provided was also mentioned 4; Conversely, the brevity of some assessments was deemed a benefit when assessing people with more limited concentration 2; 7. The utility of assessments within educational settings was deemed an important part of some assessments 2; 7. Flexibility in how information could be gathered was another consideration 1; 3. A final practical aspect reported was the observational focus and ability to use some assessments to structure observations 5; Finally, the fact that assessments were underpinned by research evidence was mentioned by one respondent.

For only two assessments 7. Unpublished assessments included those solely devised by practitioners and practitioner groups. Eight main themes were identified during the conceptual content analysis of the rationales and explanations for the development of these unpublished assessments as presented below. Unpublished assessments had in some cases been devised locally prior to participant employment within the particular setting 7; When the respondent had been instrumental in developing an assessment, the contributing factors reported were prior discussion and development with colleagues 14; For the latter, both trial and error over years of experience 2; 4.

Some unpublished assessments were reportedly adapted from other communication, developmental or behavioural assessments or from intervention approaches 17; These involved taking existing published assessments and interventions and either modifying them for use with people with PIMD or developing new assessments based on existing assessments or interventions.

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This need for adaptation was linked to the lack of existing suitable communication assessments and associated materials 17; Informal unstructured and formal structured observations were the primary forms of communication assessment for people with PIMD reported by respondents 31; These observations involved the use of everyday objects 16; Structured observations incorporated formal methods using checklists and other qualitative and quantitative methods of recording. This sometimes led to inconsistency in approach and was often reported alongside acknowledging the heterogeneity of this group of people.

It resulted in the expressed need for a more flexible approach in order to engage the individual during assessments 10; A further driver and fundamental function of developing unpublished assessments was to understand the individual communication level and preferences of the person. Therapists aimed to gauge the communication preferences and best ways to engage the person with PIMD 8; Unpublished assessments were also used to reveal how communication varied in different environments 2; 4.

Unpublished assessments were reported to provide a more comprehensive picture of a person's communication, enabling aspects of communication to be assessed which might otherwise be overlooked with formal measures 12; Practitioners used informal discussion or developed surveys and checklists with stakeholders to gather information as part of assessments 11; These were conducted with familiar interaction partners and enabled therapists to determine how consistent the description of communication was amongst different stakeholders, thus informally carrying out triangulation of sources 13; Outcomes were used to identify the optimal personal modes of communication and how to ensure that responses were consistent across communication partners in the person's environment.

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Involvement of key stakeholders in assessment also enabled negotiation of how to move forward along the developmental trajectory in communicating with the person with PIMD. A final function of the unpublished assessments was to provide a baseline from which to compare and track progress and changes in communication 17; Linked to this, individual reports showed that therapists had also developed assessments to enable staff to identify development and change by breaking down skills into smaller steps.

This was reported as supporting staff focus on aspects of communication that they might have missed and which could evidence change 2; 4. This enabled us to discern consistency and robustness of assessment processes and associated decision making. Being able to generate assessments that can reliably map progress in communication skills and that could be generalized across the work of SLTs would undoubtedly strengthen their potential to define more effective interventions and to research these with more replicability in the future. If taken up by other practitioner and researcher groups, this consistency would also strengthen the accumulating research evidence base.

The assessment in practice of communication skills is an understudied aspect of PIMD. All three, and indeed all the assessments reported, are from Anglophone countries Two from the UK and one from Australia. Moreover, they were reportedly pragmatically viable to use and supported by evidence. The Triple C assessment also met the majority of the same functions identified, with the exception of providing details of how an individual communicates.

By using these core communication assessments a shared language could be developed to enable a more robust process of communication assessment for people with PIMD to enhance intervention and research. Providing a good vehicle for discussing communication and interaction frameworks with carers and family was also cited as a reason.

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Assessments were also reportedly used as a baseline for designing and tracking the success of interventions. A mirroring of the key motivational and beneficial aspects of assessments was observed across the published and unpublished assessments. The rationales indicated some limited fitness for purpose amongst the published assessments used.

This suggests that no single assessment was considered adequate to fully assess all aspects of communication for clients with PIMD. Indeed, using a patchwork of unpublished assessments gathering information from observation, case notes and proxy stakeholder sources, alongside published assessments appeared to be common amongst participants. The robustness of such an eclectic approach and whether assessment practices were individualized to the setting where the SLT worked, their practice experience and approach e.

It is notable that unpublished assessments were more often used with older rather than younger people with PIMD. A number of potential reasons may explain this finding, but would require further investigation. Fewer assessments were specifically designed for adults 5; There may also be more focus on functional assessment in adults rendering some of the more developmentally focused child assessments to be viewed as less useful for practitioners.

Nonetheless, there was evidence of some assessments devised for children being used and adapted for adults in participant accounts. This, however, may be incorporated into the pragmatic utility rationale where participants mentioned the assessments they found easier, quicker and more flexible to use based on their experience. Limited use of empirical evidence to support assessment selection decisions was evident, suggesting the need for more work determining the efficacy of different communication assessments for people with PIMD.

Perusal of the extant literature revealed limited reliability and validity information in existence for the published assessments. It would be useful for SLTs to pay further attention to the published psychometric properties of assessments they select and their relevance to this client group.

The robustness and trustworthiness of the literature in informing practice as perceived by the SLTs needs further consideration. Further exploration of what is considered robust evidence in assessment use by practitioners working with people with PIMD is needed. This may reflect the limited commercial viability for assessments for a low prevalence group.

It appears that once practitioners begin to use an assessment they may continue to use it, even if it becomes unavailable. As the psychometric properties of this scale are now being published, and appear robust, this would appear to be a valuable addition to the assessment resources available for this underserved group.

This study is UK focused and as such cannot be generalized beyond this context. It is difficult to discern the representativeness of the sample due to lack of information regarding the number and distribution of UK SLTs working on communication with people with PIMD.

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Future research should aim to broaden this work, as assessment use may vary considerably based on setting, geographical location and availability of assessment material. A further limitation of the present study is that it solely focuses on SLTs as respondents. For younger people with PIMD, teachers are also likely to use communication assessments. Some assessments e. Parallel research work investigating assessment use by teachers is indicated. As noted, the respondent SLTs were not always clear in their description of rationales and use. For example, in some instances discerning whether a child or adult version of an assessment was being used was not fully articulated.

A final point of note is that some assessments reportedly used with people with PIMD were developmentally inappropriate and unlikely to provide beneficial information for this group e. This led to questions of how and why these assessments had been cited as used which cannot be addressed by the available data. Utilizing a survey to gather data regarding the rationales for selection of assessments was useful in gaining a breadth of information, although it sometimes led to responses which did not illuminate the thought processes behind assessment decision making e.

Nevertheless, this investigation contributes to the existing evidence base, by providing some information about the clinical rationales for assessment choice and use in a typically underserved and overlooked group. As the questionnaire was devised specifically for this project, the robustness of this approach is difficult to gauge. The questionnaire format may have also led to greater social desirability bias in responses, where practitioners may have reported their most ideal practice.

Further research utilizing observational, focus group or interview methodologies may allow more robust, and deeper understanding of assessment practices and the rationales for specific assessment use with people with PIMD to further contribute to the evidence base and guide practice developments in this area. Findings from this study showed that therapists in practice were using formal and more flexibly developed informal, unpublished assessments. Discussions with key people in the person's life augmented these assessment processes.

Communication assessment and accessing the inner world of people with PIMD are inherently challenging. In part, this could be due to the complexity of their communication needs and the lack of clear, usable, practical psychometrically robust measures available. The survey conducted here lends some indirect evidence to both of these assertions.

Unstructured work without adequate recording and charting of receptive and expressive communication was identified in a minority of responses, and these may be unlikely to guide therapists and carers towards better understanding of the specific communication needs of the person being assessed. This further highlights the need for more psychometrically valid communication assessments for this group and further development of existing assessments; some such work is underway already e.

An argument can be made that the complexity of gathering information from people with PIMD is not a valid reason for lack of rigour in assessment approaches.

Speech and Language Therapy: The Decision-Making Process When Working with Children (2nd Edition) Speech and Language Therapy: The Decision-Making Process When Working with Children (2nd Edition)
Speech and Language Therapy: The Decision-Making Process When Working with Children (2nd Edition) Speech and Language Therapy: The Decision-Making Process When Working with Children (2nd Edition)
Speech and Language Therapy: The Decision-Making Process When Working with Children (2nd Edition) Speech and Language Therapy: The Decision-Making Process When Working with Children (2nd Edition)
Speech and Language Therapy: The Decision-Making Process When Working with Children (2nd Edition) Speech and Language Therapy: The Decision-Making Process When Working with Children (2nd Edition)
Speech and Language Therapy: The Decision-Making Process When Working with Children (2nd Edition) Speech and Language Therapy: The Decision-Making Process When Working with Children (2nd Edition)
Speech and Language Therapy: The Decision-Making Process When Working with Children (2nd Edition) Speech and Language Therapy: The Decision-Making Process When Working with Children (2nd Edition)
Speech and Language Therapy: The Decision-Making Process When Working with Children (2nd Edition) Speech and Language Therapy: The Decision-Making Process When Working with Children (2nd Edition)
Speech and Language Therapy: The Decision-Making Process When Working with Children (2nd Edition) Speech and Language Therapy: The Decision-Making Process When Working with Children (2nd Edition)

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