United States

OSHA 2023

Bilingual Aphasia Assessment and Treatment

**Welcome to EMNLP 2023!**

On behalf of the EMNLP 2023 Organizing Committee, I extend a warm and heartfelt welcome to all of you to the 2023 Conference on Empirical Methods in Natural Language Processing (EMNLP). It is with immense pleasure and excitement that we gather here in Singapore, a vibrant hub of innovation and technological advancement.

The conference program is packed with insightful presentations, thought-provoking workshops, and engaging networking opportunities. In addition to the technical sessions, we have also planned several social events that will provide you with the opportunity to connect with your colleagues.

The conference is held in person at the Resorts World Convention Centre in Singapore, and available on-line with the help of Underline.

For those in Singapore, I hope that you will find time to explore the exciting Sentosa Island, Gardens by the Bay, Singapore Botanic Gardens and the many other attractions unique to Singapore.

Of course, we are grateful to our sponsors and partners for their generous support of EMNLP 2023, whose contributions make it possible for us to host this world-class event.

Yuji Matsumoto (RIKEN AIP) 
EMNLP 2023 General Chair

To access the **EMNLP 2023** event page on Underline, you need to register for the Conference. 
Please follow **[this link](https://2023.emnlp.org/registration/)** for more details.

EMNLP 2023

EMNLP 2023 took place in Singapore from Dec 6th to Dec 10th, 2023.

technical paper

The Oregon Speech-Language and Hearing Association (OSHA) is excited to present 2023 Fall Conference theme “Community in Action”. In addition to professional development content at the conference, we look forward to recognizing and celebrating the research, clinical work, and advocacy of our colleagues through our OSHA honors and awards.
![](https://assets.underline.io/markdown_image/1/image/92e74f01eb24c636be05cffbeb8a6fd5.png?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Credential=AKIAZP4XRUPAQFEPSF6P%2F20231005%2Feu-west-1%2Fs3%2Faws4_request&X-Amz-Date=20231005T092853Z&X-Amz-Expires=172800&X-Amz-SignedHeaders=host&X-Amz-Signature=46282c851bac71ec0759d4bc020befeafa87b9563672c42adee427c9a43129d5)

 
Join us from November 1st to 17th for a compelling virtual experience and continuing education opportunity to those involved in the Speech-Language & Hearing industry on the Underline platform!


#### [**OSHA 2023 On-Demand Offering**](https://drive.google.com/file/d/1jwrAmTttlBTCTRgErURL06kXcmGhJco9/view?usp=sharing)


#### [**The Official Website of the OSHA**](https://www.oregonspeechandhearing.org/fall-conference)

To access the site please register [**here**](https://www.oregonspeechandhearing.org/event-5462300). 

Please register for the 2023 OSHA Fall Conference to join the event.

The Oregon Speech-Language and Hearing Association (OSHA) promises to be a forum of growth, learning, and meaningful exchange, encompassing a rich tapestry of topics that are shaping our field in profound ways. The conference agenda is designed to address a wide array of critical subjects, each reflecting the evolving landscape of speech-language pathology. From early language and literacy development to the provision of gender-affirming and culturally responsive care, we are diving deep into the issues that matter most to our profession and the individuals we serve.

In the United States, the Individuals with Disabilities Act (IDEA) requires that school-age children with disabilities receive individualized special education services to engage in free appropriate public education. Despite this mandate, there are inequities related to speech therapy services for children living in remote/rural areas due to a shortage of speech-language pathologists (SLPs) in all regions of the United States (ASHA, n.d.). In addition, for children who stutter , there are relatively few SLPs who report feeling comfortable evaluating and treating stuttering (e.g., Coalson et al., 2016; Crichton- Smith et al., 2003). Telepractice may be one solution for connecting children who stutter who live in rural areas with SLPs who specialize in stuttering in order to provide equitable and evidence-based evaluation and treatment services as outlined by the IDEA. 

Telepractice Group Therapy for Stuttering
Using the WHO-ICF framework, group therapy for school-age children who stutter provides a functional approach to targeting the activities and participation domains. Group treatment settings have been noted to provide clients who present with communication disorders an opportunity to express their feelings, attitudes, and emotions about their speech production in a socially relevant manner (e.g., Caughter & Dunsmuir, 2017). Group treatment may also provide the opportunity for clients who stutter to: increase their participation in group communication settings, increase their self-confidence as a communicator, become desensitized to stuttering, and practice generalization of learned therapeutic strategies (e.g., self-disclosure, voluntary stuttering, stuttering modification, and/or unapologetic, open stuttering). Shoster et al. (2011) reported that people who stutter who were enrolled in group therapy for stuttering demonstrated a reduction in speaking-related anxiety. Additionally, research about the effectiveness of stuttering support groups lends support to the notion that communication situations intentionally involving other people who stutter can be helpful in reducing internalized stigma and can lead to increased levels of psychological well-being (e.g., Boyle, 2013; Yaruss et al., 2002). Given that stuttering is a low-incidence population (approximately 1%), connecting clients via telepractice in group settings is one possible way to extend these benefits to individuals who may not live in the same geographic location. 

Purpose 
The purpose of this poster presentation is to describe a telepractice group therapy program for adolescents who stutter using a comprehensive stuttering treatment protocol which addresses all components of the WHO-ICF model and fulfills IDEA guidelines. 

Method

Participants
Participants were three female adolescents who stutter (ages 12-13), who were enrolled in group telepractice treatment for stuttering for one academic year. At the onset and conclusion of group telepractice therapy, participants were evaluated using the Stuttering Severity Instrument-Fourth Edition (SSI-4; Riley, 2009) to analyze their overt stuttering frequency, duration, and secondary behaviors/physical concomitants during a conversational sample and a reading sample. In addition to this static assessment of the participants’ overt speech production, their attitudes, perceptions, and experiences related to stuttering were evaluated using the Overall Assessment of the Speaker’s Experience of Stuttering- School-Age Version (OASES-S; Yaruss & Quesal, 2006). 

Procedures
Group telepractice sessions were conducted 1x per week for 50-minutes via Zoom. Treatment included individualized activities designed to partner with the participants to achieve their treatment plan goals. Some of the benefits of providing treatment for stuttering in a group environment for adolescents are the embedded nature of aspects of the WHO-ICF framework, including desensitization to stuttering through hearing and reacting to other participants’ stuttering, inherent socialization and participation with other children who stutter who are of a similar age/grade-level, exploration of attitudes, emotions, and feelings about stuttering in a supportive, understanding environment, and practice utilizing stuttering modification strategies in generalizable contexts which mirror classroom and group work settings. 

Results
When analyzed together, the participants demonstrated variability in overt stuttering frequency, duration, and associated physical concomitants throughout the group telepractice treatment; however, all three participants exhibited a reduction in their covert stuttering and reported a decreased impact of stuttering on their lives. This clinical evidence supports the idea that group telepractice stuttering therapy can have a positive impact on participants' lives even if their overt stuttering behaviors are not significantly reduced throughout treatment.
Participants were also asked to respond to the question: “What did you learn about yourself and your communication this year?” All participants responded to the question with descriptions of increased confidence and comfort with their stuttering. For example, Participant 1 reported: 
“I feel very comfortable in my stutter now. I'm happy I'm me and not somebody else…I mean a stutter just makes me unique and like different. Sometimes it does get in the way, but I know that I will overcome it someday, and like be able to like, not stop it completely, but like to like overcome the fear of like being embarrassed or something, and be able to like know that it'll all be okay and stuff.”
Taken together, the participants’ documented clinical progress towards their communication goals, their responses to the OASES-S, and their qualitative comments indicate that group therapy via telepractice with adolescents who stutter can successfully target all aspects of the WHO-ICF framework while also meeting the individual participants’ communication needs/goals. 

Discussion and Conclusions
Telepractice offers clients who stutter the opportunity to connect with speech-language pathologists with specialty training and experience. Additionally, telepractice allows clients who stutter to connect with one another in group therapy sessions even if they are not located in the same geographic area. For example, a speech-language pathologist who splits their time between multiple school buildings may consider using telepractice as a means to connect clients who stutter and provide an opportunity for peer-to-peer connection which may not be possible with in-person treatment services. Treatment goals for adolescent children who stutter should be engaging, motivating, comprehensive in nature and focus on all components of the WHO-ICF framework. 

References:
American Speech-Language and Hearing Association (ASHA). Challenges to Successful Recruitment and Retention of School-Based SLPs. Accessed on May 17, 2021 from https://www.asha.org/careers/recruitment/schools/
Boyle, M. P. (2013). Psychological characteristics and perceptions of stuttering of adults who stutter with and without support group experience. Journal of Fluency Disorders, 38, 368–381.
Coalson, G., Byrd, C. & Rives, E. (2016). Academic, Clinical, and Educational Experiences of Self-Identified Fluency Specialists. Perspectives of the ASHA Special Interest Groups, 1, 16-43. 
Crichton-Smith, I., Wright, J., and Stackhouse, J. (2003). Attitudes of speech and language therapists towards stammering: 1985 to 2000. International Journal of Language and Communication Disorders, 38, 213–234.
Caughter, S. & Dunsmuir, S. (2017). An Exploration of the Mechanisms of Change Following an Integrated Group Intervention for Stuttering, as Perceived by School-Aged Children who Stutter. Journal of Fluency Disorders, 51, 8-23. 
Riley, G. D. (2009). Stuttering Severity Instrument–Fourth Edition (SSI-4) (3rd ed.). Austin, TX: Pro-Ed.
Shoster, D. & Davidovikj, N. & Filipova, S. & Lozanovska, B. (2011). The Importance of Group Therapy Used in the Treatment of Stuttering. Journal of Special Education and Rehabilitation, 12, 77-89. 
Yaruss, J. S., Quesal, R. W., Reeves, L., Molt, L. F., Kluetz, B., Caruso, A. J., . . . Lewis, F. (2002). Speech treatment and support group experiences of people who participate in the National Stuttering Association. Journal of Fluency Disorders, 27, 115–134.
Yaruss, J. S. & Quesal, R.W. (2006). Overall Assessment of the Speaker's Experience of Stuttering (OASES): Documenting multiple outcomes in stuttering treatment. Journal of Fluency Disorders, 31(2), 90–115.

Telepractice Group Therapy for Stuttering with Adolescents

Literature Review: 

The origins of DA stem from the seminal work in the discipline of cognitive psychology. Feuerstein’s thesis was that learning potential could be identified and measured by using an interactive and dynamic assessment methodology engaging a student in a learning activity, while also recording a student’s need for modifiability (Feuerstein, et al.,, 1953; Guthke & Wingenfeld, 1992, Hayword & Lidz, 2007). The contemporary use of DA utilizes two primary theoretical frameworks: The zone of proximal development (Vygotsky et al., 1978) and the mediated learning experience (Feuerstein et al., 1979). DA continues to be researched and used within cognitive and educational psychology, and over the last 25 years it has been adopted and implemented within the discipline of communication disorders (Bamford, et al., 2022; Lidz & Pena, 1996). 

Multiple reviews on DA in the field of CSD (Bamford et al., 2022; Hunt et al., 2022; Orellana et al., 2019) have provided evidence for the effectiveness of incorporating DA into evaluations. Studies have concluded that DA provides a context where a language disorder may be detected in students from CLD backgrounds. The highest sensitivity and specificity values have resulted when posttest scores are combined with modifiability ratings (e.g., Petersen et al., 2020). The reviews have also yielded insight into the various forms that DA can take in terms of language skills being assessed, how learning is measured, and intensity of teaching sessions.

Summary of Proposal: 

Speech-language pathologists (SLPs) play an integral role in conducting evaluations with bilingual students (ASHA, 2010). To assess language abilities in bilingual speakers, students should be assessed in all of the languages they speak (e.g., ASHA, 2010). Failure to do so can be an under- and overidentification of students from culturally and linguistically diverse backgrounds identified as having a communication disorder (Artiles & Ortiz, 2002; Pena, 2000; Pena, et al., 2001). Authentic assessments, such as language sampling and dynamic assessment (DA), align with best practices for bilingual assessments (e.g., Orellana et al., 2019). Language sampling is increasingly used with students from culturally and linguistically diverse (CLD) backgrounds; however, DA is less frequently used (e.g., Garman 2015). DA methods incorporating a test-teach-retest methodology provides quantitative and qualitative evidence about a student’s ability to learn, retain, and transfer of language-based information (Orellana et al., 2019; Lidz, 1991). 

Determining the presence of a language disorder is a complex process. DA provides crucial information about the learning process that can be considered along with other converging evidence in the clinical decision-making process. Unfortunately, DA continues to be underused by SLPs in bilingual pre-referral processes and evaluations. For DA to be integrated into SLPs’ comprehensive evaluations, an exploration of barriers to implementation is warranted. Several barriers to implementing DA in practice were identified through the review of the DA literature and the authors’ experiences working with districts and SLPs. The first barrier is SLPs’ lack of confidence using DA (Gorman, 2015). An underlying problem is that of inadequate professional learning (PL) opportunities for SLPs. Districts are urged to rethink PL approaches and to adhere to the evidence based standards for PL (Learning Forward, 2011). The evidence is clear that passive inservices do not result in changes in practice. Rather, job-embedded learning opportunities in small-group learning communities with coaching, modeling, and feedback results in adult learners trying and sustaining new practices (e.g. Darling-Hammond et al., 2009). 

Thus, a critical recommendation for clinical practice is for district leadership to support efforts at high quality PL that follow the Learning Forward (2011) standards that allow for SLPs and other specialists to learn how to effectively and efficiently plan and implement DA and to analyze results. The authors recommend that districts invest in PL facilitators in learning communities where SLPs can explore how to plan, implement, and analyze results for speech, language/literacy & social communication DA. Those new to the practice need scaffolds including checklists, protocols, and scripts; support with using modifiability scales; and opportunities to talk through their analysis of student performance. One area for future research is to analyze the success of the PL experiences using Guskey’s (2005) model. 

A second barrier to DA implementation concerns the complexity of DA itself. According to Bamford et al. (2022), the wide scope of DAs and the variability in methods used are both a strength of DA and a barrier to action. A recommendation to assist with this is providing checklists (e.g. Mitchell, 2021, 2022), protocols, and scripts specific to language and social language targets being selected and used across ages. An area for future research is to examine the clinicians’ fidelity using such protocols and scripts. 

A third barrier has to do with conditioned belief systems that have perpetuated over time. This occurs due to school professionals' misunderstandings of current IDEA statutes (IDEA, 2004) for SPED evaluations. This contributes to the perception that DA does not meet the threshold of evaluation standards. In 2004, the reauthorization of IDEA codified into federal statute guidelines allowing for the use of assessment methods, such as DA. One recommendation is to provide SLPs with the knowledge and language to use to advocate for the use of DA and to advocate for omitting norm-referenced assessments when they are not valid. 

SLPs have been called to implement DA practices which have been recognized in the literature for over two decades within the CSD discipline, but as a field we have underused them as an assessment methodology. The barriers and recommendations are offered here to guide SLPs with options and actions to engage in DA practices. 


Statement of Purpose:

The purpose of this poster is twofold. The first aim is to identify barriers that preclude SLPs from adapting DA into their evaluation practices. The second aim is to present recommendations to facilitate DA practices within a professional learning community.


Outline:
The outline for the presentation is as follows: 

1. Background and rationale
2. Discuss supports for SLPs with planning, implementing, and analyzing dynamic assessment within a professional learning community 
3. Discuss the power of PLCs: new knowledge, access to EBP and interactive learning, job-embedded practice, sustained practice, network of support

Select References 

American Speech-Language-Hearing Association. (2010). Roles and responsibilities of speech-language pathologists in schools [Professional issues statement].
https://www.asha.org/SLP/schools/prof-consult/guidelines/

Bamford, C.K., Masso, S. Baker, E., & Ballard, K. J. (2022). Dynamic assessment for children
with communication disorders: A systematic scoping review and framework. American Journal of Speech-Language Pathology, 31, 1878-1893. 

Bender, F. W., (2005). Evaluating and serving culturally and linguistically diverse students: A
process approach to reduce the under and over identification of ELL students being considered for SPED services (unpublished). National CEU Presentation Resource Manual, Portland, Oregon.

Darling-Hammond, L., Wei, R. C., Andree, A., Richardson, N., & Orphanos, S. (2009). 
Professional learning in the learning profession: A status report on teacher development 
in the United States and abroad. Published by the National Staff Development Council 
and the School Redesign Network at Stanford University.

Dollaghan, C. A., & Horner, E. A. (2011). Bilingual language assessment: A meta-analysis of 
diagnostic accuracy. Journal of Speech, Language, and Hearing Research, 54, 1077–1088.

Gorman, B. K. (2015). Dynamic assessment with bilinguals: A focus on increasing clinician’s 
confidence. Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations, 22, 112-121

Guskey, T. R. (2005). Taking a second look: Strong evidence reflecting the benefits of 
professional development is more important than ever before. Journal of Staff
Development, 26(1), 10-18.

Gutierrez-Clellen, V.F., & Peña, E. (2001). Dynamic assessment of diverse children: A tutorial.
Language, Speech, and Hearing Services in Schools, 32(1), 212-224.

Hunt, E., Nang, C., Meldrum, S., & Armstrong, E. (2022). Can dynamic assessment identify
language disorder in multilingual children? Clinical applications from a systematic
review. Language, Speech, and Hearing Services in Schools, 1-28.
https://doi.org/10.1044/2021_LSHSS-21-00094

Individuals with Disabilities Education Act (IDEA,2004). Federal Register, Volume 71, No. 156. Part II, Department of Education, 34, CFR parts 300 & 301.

Learning Forward (2011). Standards for professional learning. Oxford, OH: Author. 
https://learningforward.org/

Lidz, C. S. (1991). Practitioner’s Guide to Dynamic Assessment. Guilford Press.

Mitchell, M. P. (2021, November 18). Designing Dynamic Assessment for Vocabulary. Poster 
session at the American Speech-Language-Hearing Association National Convention, 
Washington DC.

Mitchell, M. P. (2022, November 17). Planning Dynamic Assessment Around Relative Clauses. Oral session at the American Speech-Language-Hearing Association National
Convention, New Orleans, LA.

Orellana, C. I., Wada, R., & Gillam, R. B. (2019). The use of dynamic assessment for the 
diagnosis of language disorders in bilingual children: A meta-analysis. American Journal of Speech-Language Pathology, 28, 1298-1317. https://doi.org/10.1044/2019_AJSLP-18-0202

Peña, E. (2000). Measurement of modifiability in children from culturally and linguistically
diverse backgrounds. Communication Disorders Quarterly, 21(2), 89-97.

Peña, E. D., Iglesias, A., & Lidz, C. S. (2001). Reducing test bias through dynamic assessment of children’s word learning ability. American Journal of Speech-Language Pathology, 10, 138–154. https://doi.org/10.1044/1058-0360(2001/014)

Petersen, D. B., Tonn, P., Spencer, T. D., & Foster, M. E. (2020). The classification accuracy of 
a dynamic assessment of inferential word learning for bilingual English/Spanish-speaking school-age children. Language, Speech, and Hearing Services in Schools, 51, 144-164. 

Vygotsky, L. S. (1986). Thought and language. MIT Press.

Professional Learning Communities in Action: Dynamic Assessment

Background
CSD programs are utilizing simulation as a pedagogical tool to support student learning and development of clinical skills. Simulation experiences are designed to allow students to practice clinical skills in a low-stakes environment and to increase standardization and equity across student learning experiences (Dudding et al., 2019; Quail et al., 2016). Another benefit of simulation is the ability to observe student performance to ensure professional competency and observe skills prior to students’ initial clinical placements (Macbean, Theodoros, Davidson & Hill, 2013). Simulation pedagogy includes various methods, but one prominent method is utilization of standardized patients (SPs) which introduces a high level of fidelity to simulation experiences given the SPs ability to respond and react to students (Zraick, 2020). SPs are trained to simulate a patient in a repeatable, standardized manner in order to ensure similar learning opportunities for all students (Dudding and Nottingham, 2018). 

Pacific University uses a community-based clinical model where students are placed with community supervisors for all practicum experiences. As such, clinical faculty work diligently to form and maintain relationships with speech-language pathologists (SLPs) in the community to develop, not only clinical placements but, meaningful learning experiences in the graduate program for students to gain “hands-on” experience before their first practicum in the spring semester. The Clinical Methods and Observation course (CSD 521), completed in the first-semester of the graduate speech-language pathology program, is a foundational training course for development of students’ clinical skills prior to external clinical placements in the local community. Historically, graduate students in CSD 521participate in active learning related to hearing screening procedures in a class lab. Students were introduced to the rationale for providing hearing screenings, procedure protocol, and how to provide results to patients or caregivers. In lab, students have practiced using audiometers to complete the hearing screening protocol one to two times with lab partners. Following this preparation, students were sent out to schools in the local community to assist the school’s SLP with hearing screenings. Generally this method of preparation was successful, but students commented that more structured practice and feedback prior to working with clients would be beneficial. 

Given this student feedback, the course instructors determined that inclusion of a high-fidelity, high-quality simulation allowing students to practice a hearing screening procedure with a standardized patient could bridge the gap from class to clinic. The instructors reviewed the current simulation evidence in communication disorders and sciences (CSD) and designed “perfect practice” opportunities for students to learn the hearing screening technical procedure. Following this practice, students were expected to participate in a simulation utilizing a SP to learn the nuance of working with a live client, tracking responses online, and managing client questions and behaviors. 

Purpose 
The purpose of this study was to investigate the performance and perception of graduate students following a simulated learning experience focused on administering and analyzing results of an adult hearing screening. Investigators worked to answer three main questions, including (1) How did students perform on the simulation, (2) What did students think about the simulation, and (3) Is there a relationship between how the student performed on the simulation and how they rated it?

Methods
This simulation was completed by 32 SLP students in their first semester of graduate school before students conducted hearing screenings in the community. The objectives were: (1) Introduce yourself/explain the task in clear terms without clinical jargon, (2) Complete a hearing screening following the appropriate procedure per protocol, (3) Demonstrate clinical/critical thinking skills throughout the encounter, and (4) Use an audiometer accurately and efficiently.

Prior to the simulation students were provided with pre-learning materials, the clinical educators reviewed the simulation objectives, and the hearing screening procedure was modeled. Students practiced with each other during a lab and open practice day with access to the audiometers and mannequins to practice with faculty present to answer questions. 

On simulation day, the supervising educator led students through a scripted pre-brief. The students individually administered a hearing screening to an adult SP. The supervising educators used a rubric to evaluate each student's clinical and communication skills. Once the simulation was completed, students debriefed with their supervising educators. The supervising educators led debrief session using the PEARLS method which provided students a structured outline for reflections related to the simulation, their feelings related to performance, and knowledge acquired from the simulation experience (Walter & Cheng, 2015). Following the debriefing session, students completed a Qualtrics survey to evaluate their performance and the simulation itself.


Results
Preliminary review of the data collected by clinical educator rubrics revealed the following:
- 81% (26/32) of students met criteria for explaining the task
- 81% (26/32) of students met criteria for following the hearing screening protocol
- 97% (31/32) of students met criteria for demonstrating critical/clinical thinking skills
- 66% (21/32) of students met criteria for using the audiometer efficiently

Common feedback for students from clinical educators was: ensure the client is facing away from the student clinician, apply headphones on correct ears, minimize jargon, and consider ergonomics for using audiometer while collecting data. 

Immediately following the escape room, students completed a Qualtrics surveyto provide feedback across several simulation design and implementation areas, including a) structure, b) receiving guidance and feedback, and c) debriefing about their learning. Data is yet to be analyzed, but preliminary review appears to show that students are confident that they are learning the content of the simulation and this simulation covers critical content to prepare them for clinical practice. Qualitative feedback from the survey indicated that students were happy to have the opportunity to make mistakes in a low-stakes environment, so they would be more successful with their first clinical experience.

Conclusions/Implications 
The outcomes of this study suggest that students benefit from practicing hearing screenings in a simulated context to increase clinical confidence prior to their initial community placements. This work has positive implications for student teaching and training, as well as potential for carryover to clinical contexts to improve hearing screening practical skills in early-career SLPs.


References

Dudding, C. D., Brown, D. K., Estis, J. M., Szymanski, C., Zraick, R., & Mormer, E. (2019). Best Practices in Healthcare Simulations in Communication Sciences and Disorders Guide. Counsel of Academic Programs in Communication Science and Disorders. Available from: https://members.capcsd.org/news/Details/capcsd-ebook-best-practices-in-healthcare-simulations-in-communication-sciences-and-disorders-guide-8147 


Dudding, C.C. & Nottingham, E. E. (2018). A national survey of simulation use in university programs in communication sciences and disorders. American Journal of Speech Language Pathology, 27(1), 71-81. https://doi.org/10.1044/2017_AJSLP-17-0015 


MacBean, N., Theodoros, D., Davidson, B., & Hill, A. E. (2013). Simulated learning environments in speech-language pathology: an Australian response. International journal of speech-language pathology, 15(3), 345–357. https://doi.org/10.3109/17549507.2013.779024 


Quail, M., Brundage, S. B., Spitalnick, J., Allen, P. J., & Beilby, J. (2016). Student self-reported communication skills, knowledge and confidence across standardized patient, virtual and traditional clinical learning environments. BMC Medical Education, 16(1), 73. https://doi.org/10.1186/s12909-016-0577-5 


Walter, E. & Cheng, A. (2015) Promoting Excellence and Reflective Learning in Simulation
(PEARLS), Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare,
10(2), 106-115. https://www.doi.org10.1097/SIH.0000000000000072 


Zraick, Richard I. (2020) "Standardized Patients in Communication Sciences and Disorders: Past, Present and Future Directions," Teaching and Learning in Communication Sciences & Disorders, 4(3) https://doi.org/10.30707/TLCSD4.3/KHSI3441 



Using Simulation Practices to Refine Clinical Skills for Hearing Screenings

"Background
Clinical communication, terminology use, adaptation of the assessment tasks, responses to patient behavior, and appropriate preparation for assessment are key elements to effective cognitive assessment in clients with traumatic brain injury. Effective assessment of cognition for users of augmentative and alternative communication (AAC) requires special attention to multimodal communication techniques and consideration of cognitive demands of the AAC tools (Wallace, 2010). Students may not have opportunities to engage with AAC users in this way during their clinical placements. Barman et al. (2023) demonstrates that graduate students who have multiple opportunities to utilize AAC in clinical experiences feel more prepared to work with users of AAC after graduation.

Simulation has been shown to provide a safe environment in which students can practice and demonstrate these skills. Simulations can increase standardization, equity, consistency of student skill development and to provide a safe learning environment for clinical training (Dudding et al., 2019; Quail et al., 2016). Another advantage of using simulation in clinical education is the ability to simulate medically fragile or low incidence patients (e.g. NICU babies, tracheostomy care, COVID patients, ventilated patients, etc.). This ensures that students will have further development in these areas despite possible lack of exposures in clinical placements. Due to the limited opportunities for traditional clinical placements in medical SLP, simulations offer unique opportunities for clinical training among SLP graduate programs (Stead et al., 2020).

Standardized Patients (SPs) are one prominent method of simulation that provides a high level of fidelity. This form of simulation utilizes a person simulating a patient in a standardized, repeatable way (Dudding and Nottingham, 2018). Zraick (2020) described the current use of SPs in simulation education as a way to reach high fidelity and standardization across training experiences in a low stakes environment. Inclusion of SPs into a clinical skills program is perceived by faculty and students to be a valuable approach to learning a broad array of clinical skills. 

Purpose 
The purpose of this study was to investigate the performance of graduate students following a simulated evaluation of a 28 year old patient who had been admitted to the hospital with a traumatic brain injury and flaccid dysarthria secondary to falling in the shower and hitting her head. It was necessary to adapt assessment tools to accommodate the patient's AAC use. Investigators worked to answer four main questions, including:
How did students perform on administering a cognitive evaluation?
How did students support patient communication through utilization of AAC?
How do students think the simulation impacted their learning?
What did students think about the simulation design? 

Methods
The design of this simulated experience was based on the International Nursing Association for Clinical Simulation and Learning’s standards (INACSL; 2021), which promote rigorous training methods in simulation. This simulation was completed by 34 second year graduate students at the end of their 4th semester in the Master’s of Speech-Pathology program. One week prior to the simulation students were provided with all pre-learning materials. The educators also reviewed the simulation design, objectives, and modeled each assessment task (orientation and language comprehension, story memory, figure copying, line orientation, and trails) for the simulation as well as provided them an opportunity to see the patient’s AAC board. 

On simulation day, students arrived in groups of five and their supervising educator led them through a scripted, pre-brief lasting approximately 5 minutes. The students then completed the 25 minute simulation with the standardized patient following the predetermined script below. 

Simulation Outline - Student Actions
** Please say quoted words as cues for the standardized patient and your group members.
All: Group enters room
Student 1: 
Greet and introduce as SLP; Explain the assessment plan and ensure they have the proper support/tools to respond

“The place we are going to start is …”

(STUDENT 1 ADMINISTERS ORIENTATION & LANGUAGE COMPREHENSION)

“Great work, now we will try something else.”
Student 2:
“Next, I’m going to ask you to…”

(STUDENT 2 ADMINISTERS STORY MEMORY)

“You’re doing great, now let's change directions.”
Student 3:
“Now I’ll have you…”

(STUDENT 3 ADMINISTERS FIGURE COPYING)

“Thanks for your hard work, I just have a couple of more tasks for you.”
Student 4:
“Now I am going to ask you to…”

(STUDENT 4 ADMINISTERS LINE ORIENTATION)

“Alright, now we will try something else.”
Student 5:
“Finally, I am going to ask you to….”

(STUDENT 5 ADMINISTERS THEIR ASSESSMENT SUBTEST/S)

“Nice work on that task”

“Thank you so much for your time today...  I look forward to working with you soon and I hope you have an excellent rest of your day” 
ALL: Get up and exit room


The supervising educator used a rubric to evaluate each student's skills: (a) clinical communication, (b) terminology use, (c) adaptation of the assessment task (d) responses to patient, and (e) evidence of preparation. Once completed, supervising educators led the debrief session using the PEARLS method providing students a structured outline for reflections related to the simulation, their feelings related to performance, and knowledge acquired from the simulation. Following the debriefing, students completed a survey evaluating their simulation performance as well as provide feedback on the simulation itself. 


Conclusions/Implications 
Results from this simulation indicate a majority of students have emerging or have developed effective skills for assessing a person with ABI.  Students demonstrated the most proficiency in administering the trails task and the least proficiency within the story memory tasks. Students struggled most with adapting the task so that an AAC user could participate. Student feedback about the simulation was resoundingly positive and remarked how the simulation advanced their learning, helped them to reflect on assessment skills, and provided them with exposure to a patient with limited verbal communication. One student remarked, “I appreciated the low stakes environment and gained some good insights into interactions with folks who are using low-tech AAC.” Students provided positive feedback on aspects of the simulation design and implementation. This work has implications for student training and potential for carryover to clinical contexts to improve effective assessment skills in early career speech-language pathologists. 

References

Barman, B. E., Dubasik, V. L., Brackenbury, T., & Colcord, D. J. (2023). Graduate Students' Perceived Preparedness and Confidence to Work With Individuals Who Use Augmentative and Alternative Communication. American Journal of Speech-Language Pathology, 1-17.
https://doi.org/10.1044/2023_AJSLP-22-00282
Dudding, C. D., Brown, D. K., Estis, J. M., Szymanski, C., Zraick, R., & Mormer, E. (2019). Best Practices in Healthcare Simulations in Communication Sciences and Disorders Guide. Counsel of Academic Programs in Communication Science and Disorders. Available from: https://members.capcsd.org/news/Details/capcsd-ebook-best-practices-in-healthcare-simulations-in-communication-sciences-and-disorders-guide-8147 
Dudding, C.C. & Nottingham, E. E. (2018). A national survey of simulation use in university programs in communication sciences and disorders. American Journal of Speech Language Pathology, 27(1), 71-81. https://doi.org/10.1044/2017_AJSLP-17-0015 
INACSL Standards Committee, Hallmark, B., Brown, M., Peterson, D., Fey, M., Decker, S., Wells-Beede, E., Britt, T., Hardie, L., Shum, C., Arantes, H., Charnetski, M., & Morse, C.  (2021).  Healthcare Simulation Standards of Best PracticeTM Professional Development.  
Quail, M., Brundage, S. B., Spitalnick, J., Allen, P. J., & Beilby, J. (2016). Student self-reported communication skills, knowledge and confidence across standardized patient, virtual and traditional clinical learning environments. BMC Medical Education, 16(1), 73. https://doi.org/10.1186/s12909-016-0577-5    
Stead, A., Lemoncello, R., Fitzgerald, C., Fryer, M., Frost, M., & Palmer, R. (2020). Clinical simulations in academic courses: Four case studies across the medical SLP graduate curriculum. Teaching and Learning in Communication Sciences & Disorders, 4(3), 6.
Wallace, S. E. (2010). AAC use by people with TBI: Affects of cognitive impairments. Perspectives on augmentative and alternative communication, 19(3), 79-86.
Zraick, Richard I. (2020) ""Standardized Patients in Communication Sciences and DIsorders: Past, Present and Future Directions,"" Teaching and Learning in Communication Sciences & Disorders, 4(3) https://doi.org/10.30707/TLCSD4.3/KHSI3441 "

Learning Through High Fidelity Simulation: Assessing Acquired Brain Injury

Background
Speech-language pathologists (SLP) roles and responsibilities are impacted when working with clients with hearing loss. The American Speech-Language and Hearing Association (ASHA) has stated that SLPs working with individuals with hearing impairments should have specific education and training related to this population. Interprofessional education can serve to meet this need. 

Simulation has been shown to provide a safe environment in which students can practice and demonstrate skills. In addition, simulations have increased standardization, equity, and consistency of student skill development and provided a safe learning environment for student clinical training (Dudding et al., 2019; Quail et al., 2016). Interprofessional simulations are used regularly to educate students going into specific healthcare professions. However, disciplines such as audiology (AUD), SLP, and others have yet to participate regularly in interprofessional simulation work (Eichorn et al., 2021). Interprofessional simulations are beneficial, especially when partnered with similar healthcare disciplines (Alanazi & Nicholson, 2017; Bordurant, 2020; Eichorn et al., 2021). 

In addition to simulation, research has also shown that peer teaching others a subject helps retain information better and improves class performance (Rusli et al., 2021; Williams & Nguyen, 2017). Communication skills are also beneficial as students become more comfortable with the material in-depth and teach accurately (Rusli et al., 2021; Finn et al., 2023; van Vuuren, 2017). 

Purpose
This study aimed to investigate the performance and perception of graduate students following an interprofessional peer-taught simulated learning experience focused on hearing assistive technology (HAT). Investigators worked to answer three main questions, including:
Did a hearing assistive technology simulation impact SLP students' self-efficacy?
What did SLP students think about the simulation?
What was the experience of peer educators in teaching hearing assistive technology?

Methods
The standards outlined by the International Nursing Association for Clinical Simulation and Learning (INACSL, 2021) were rigorously used to design this learning experience. Thirty-five first-year SLP graduate students completed this simulation in their 3rd semester in the Master of Speech-Pathology program. Students were provided with all pre-learning materials in their clinical seminar course one week before the simulation. The clinical educators reviewed the simulation design and objectives, which included the following:
Explore a variety of hearing aids types, charging styles, and hearing assistive technologies 
Demonstrate proper insertion of both hearing protection and hearing aids
Experience what it is like to hear through a hearing aid to build patient empathy
Explore different patient scenarios and identify solutions to solve hearing-related barriers
Increase comfort with hearing aids and hearing assistive devices and troubleshoot patient hearing difficulties

All students were led through a scripted, 10-minute pre-brief on simulation day. The simulation had two components (1) The AuD peer educators presented a presentation to SLP students to lay a foundation of background information for the profession of audiology, hearing loss, and amplification, and (2) Then students broke into small groups of 6, and an AuD peer educator-led a scripted experience or simulation at each station. Each simulation station lasted approximately 30 minutes. These stations included:
Hearing assistive technology (HAT) explorations - experiential: Students explored different forms of HAT and learned how they could be utilized.
Troubleshooting and Cleaning - simulation: Students explored different patient scenarios and demonstrated problem-solving hearing-related barriers.
Insertion Practice - simulation: Students practiced inserting a hearing aid in a peer student and a custom hearing aid into an instructor while troubleshooting fit issues.
Charging options and Hearing Aid Styles - experiential: Students experienced what it was like to hear through a hearing aid to build patient empathy
Hearing Protection - simulation: Student learned and demonstrated how to insert hearing protection properly
Listening to Hearing aids - simulation: Students learned about different types of hearing aids and charging styles and demonstrated testing and changing batteries. 
Once all simulations were completed, the students moved into a structured debrief utilizing the PEARLS method. It gave students a structured outline for reflections on the simulation stations, their feelings about performance, and knowledge acquired from the simulation experience. 

Results
Student self-efficacy in using HAT was measured at three intervals surrounding the simulation. 1-week pre-simulation, immediately following, and six months post-simulation. The survey self-efficacy responses were analyzed using basic descriptive statistics and paired sample t-tests. Pre- to post-test changes in self-efficacy were statistically (p = 0.00) in all seven of the evaluated skill areas. Furthermore, Pre- to Post-post test changes remained statistically significant even with some decline in self-efficacy. Students also provided positive feedback regarding being taught by peer educators, including statements such as "It was a wonderfully comfortable learning opportunity where we could engage with peers."

For the peer audiology teachers, a survey was created for post-simulation assessment. 
Student reflection was largely positive on peer teaching students indicated high levels of agreement (average 8.9 on ten a point Likert scale) for the following statements:
By teaching, I became more confident about the topic.
I enjoy helping peers learn about my discipline.
I effectively taught my area of expertise today.
Teaching enhanced my learning.
I want to teach again to my fellow students.

Peer-teaching students indicated they struggled most with answering novel student questions.
Students also provided feedback on the simulation via a post-debrief Qualtrics survey. Results indicated that students responded positively to a) simulation structure, b) opportunities for guidance and feedback, c) working with peers, and d) debriefing about their learning. On these surveys, students consistently indicate that they are confident that:
they are mastering the content of the simulations;
the simulations cover critical content necessary for the mastery of the curriculum;
they are obtaining the required skills and knowledge from the simulations to perform tasks in clinical settings.

Conclusions/Implications 
Results from this simulation indicate that students demonstrated increased self-efficacy following an interprofessional peer-taught HAT simulation. In addition, student feedback about the simulation was resoundingly positive. Further results will be discussed within the presentation. This work has implications for student teaching and training and the potential for carryover to clinical contexts. 

References

Alanazi, A. A., & Nicholson, N. (2017). Students’ evaluation of audiology simulation training. [L’évaluation des étudiants d’une formation en audiologie utilisant des mises en situation] Canadian Journal of Speech-Language Pathology and Audiology, 41(3), 289. Retrieved from http://proxy.lib.pacificu.edu:2048/login?url=https://www.proquest.com/scholarly-journals/students-evaluation-audiology-simulation-training/docview/2003760500/se-2


Bondurant, L. M. (2020). Breaking down silos: Interprofessional collaborative practice in humanitarian audiology. Seminars in Hearing, 41(2), 092. doi:https://doi.org/10.1055/s-0040-1708506


Dudding, C. D., Brown, D. K., Estis, J. M., Szymanski, C., Zraick, R., & Mormer, E. (2019). Best Practices in Healthcare Simulations in Communication Sciences and Disorders Guide. Counsel of Academic Programs in Communication Science and Disorders. Available from: https://members.capcsd.org/news/Details/capcsd-ebook-best-practices-in-healthcare-simulations-in-communication-sciences-and-disorders-guide-8147 

Eichorn, N., Zarn, M., Moncrieff, D., Sposto, C., Lee, S., Hoffman, J. E., Levy, M., & Caplan, J. (2021). Original Interprofessional Simulations to Train Students in CSD and Related Health Professions in Team-Based Health Care. Communication Disorders Quarterly, 43(1), 23–31. https://doi.org/10.1177/1525740120942127

Finn, E., Hewetson, R., Howells, S., Clifton, J., & Cardell, E. (2023). What students can teach each other: Promoting optimal voice use for teaching through a speech-language pathology student-led voice clinic. Teaching & Teacher Education, 125, N.PAG. https://doi.org/10.1016/j.tate.2023.104053

Gottlieb, S., Martin, C., Nichols, C., & Edmondson, A. (2014). Student peer teaching in the anatomy lab enhances anatomy performance in the lowest quartile of allied health students (211.5). FASEB Journal, 28, N.PAG. https://doi.org/10.1096/fasebj.28.1_supplement.211.5

INACSL Standards Committee, Hallmark, B., Brown, M., Peterson, D., Fey, M., Decker, S., Wells-Beede, E., Britt, T., Hardie, L., Shum, C., Arantes, H., Charnetski, M., & Morse, C. (2021). Healthcare Simulation Standards of Best PracticeTM Professional Development. Clinical Simulation in Nursing, https://doi.org/10.1016/j.ecns.2021.08.007. 

Rusli, M., Degeng, N. S., Setyosari, P., & Sulton. (2021). Peer teaching: Students teaching students to increase academic performance. Teaching Theology & Religion, 24(1), 17–27. https://doi.org/10.1111/teth.12549


Quail, M., Brundage, S. B., Spitalnick, J., Allen, P. J., & Beilby, J. (2016). Student self-reported communication skills, knowledge and confidence across standardized patient, virtual and traditional clinical learning environments. BMC Medical Education, 16(1), 73. https://doi.org/10.1186/s12909-016-0577-5 


Van Vuuren, S. (2017). An integrated literature review of undergraduate peer teaching in allied health professions. African Journal of Health Professions Education, 9(1), 9–12. https://doi.org/10.7196/AJHPE.2017.v9i1.588

Williams, B., & Nguyen, D. (2017). Near-peer teaching in paramedic education: A repeated measures design. Innovations in Education & Teaching International, 54(4), 345–354. https://doi.org/10.1080/14703297.2016.1146623

Hearing Assistive Technology as Taught in a Simulated Interprofessional Environment

Background:

Augmentative and alternative communication (AAC) can mitigate the impact of communication disorders by providing an immediate mode for functional communication and visual supports to enhance comprehension while toddlers’ speech and language skills are developing (Light and McNaughton, 2012). Though AAC interventions improve children’s language, literacy, social, and adaptive skills, they are rarely initiated with toddlers during a critical period in language development (Guralnick, 2017). Timely provision of AAC intervention is vital because developing foundational functional communication and early symbolic skills are necessary to help toddlers learn vocabulary and transition to combining words (Light, et al, 2019). Caregivers of children with IDD often receive minimal instruction on AAC and supporting communication with their children at home (Baggett, et al., 2010). Without individualized, family-centered instruction, caregivers are unprepared to support AAC use and language learning at home. One promising method for expanding access to AAC intervention is teaching caregivers to use AAC and language facilitation strategies using hybrid (in-person and telehealth) models (Quinn, et al., 2021). Our goal is to understand caregivers’ preferences for an AAC intervention and the challenges of using AAC with toddlers at home. This knowledge is critical to the future success of AAC interventions because AAC interventions for toddlers lack robust social validation (Goldstein, 2016). Additionally, caregivers’ perceptions of intervention feasibility and acceptability impact intervention adoption.


Summary of Proposal:
The purpose of this study was to determine caregivers’ preferences and needs regarding two key AAC intervention components: (a) service delivery (b) strategies to enhance treatment adherence. As this research is preliminary, this poster presentation will highlight pertinent themes collected during the interview coding process. Additionally, this presentation will explore caregiver-identified barriers to successful AAC intervention implementation and discuss intervention features that may support successful outcomes in the home environment. This knowledge is critical to the future success of AAC interventions because caregivers’ perceptions of intervention feasibility and acceptability impact intervention adoption.


Purpose:
The purpose of this study was to determine caregivers’ preferences and needs regarding two key AAC intervention components: (a) service delivery and (b) strategies to enhance treatment adherence. In this project, treatment adherence strategies refer to the techniques, methods, and approaches that help family members use AAC systems and AAC intervention strategies at home. Examples may include text-message reminders, tip sheets, and caregiver instruction.


Method: 
A grounded theory approach (Corbin & Strauss, 2015) was used to collect and code caregiver interviews. Qualitative methods were applied to allow for in-depth, inductive, and dynamic exploration of factors that impact AAC use at home. Constant comparative analysis (Cresswell & Poth, 2018) was used to derive emergent themes.
Participants and setting: 
17 caregivers of children with IDD (24 – 58 months) who received early intervention services completed interviews conducted via a virtual platform. Purposive sampling strategies were used to recruit caregivers with diversity in social demographic characteristics.


Design and procedures: 
A semi-structured interview protocol was developed and revised with feedback. Questions inquired about caregivers’ global perceptions of AAC, experiences with community-based early intervention, preferences for strategies to increase treatment adherence, and preferences for service delivery. The researchers followed a three-step data processing method. First, the audio files were uploaded to Otter.Ai transcription service to prepare a verbatim transcript. Next, a researcher reviewed the entire transcription against the audio recording for accuracy and removed identifying details. Last, the cleaned transcripts were uploaded to NVivoR1.7.1 for analysis. Each interview transcript is being coded independently using an inductive and iterative process following the constant comparative method.

Results: 
Results are preliminary in nature as coding is currently in progress. Strong themes have emerged as coding has been conducted in both (a) service delivery and (b) strategies to enhance treatment adherence. Caregivers identified that in-person service delivery models promote: a) hands-on learning and caregiver self-efficacy, b) supports stronger relationships between therapist, child and caregiver (especially during the initial aspects of therapy), and c) removes the possibility of experiencing technical issues that can occur during telehealth. Caregivers identified that telehealth service delivery models promote: a) greater availability of speech-language pathologists, b) it often works better for direct parent-therapist interactions, and c) it can decrease domestic load (e.g., cleaning the house in preparation for a provider to visit, arranging schedules to be at home for the visit, etc). Caregivers identified several strategies that promoted greater adherence to treatment protocol and/or recommendations including: a) concrete and easily accessible information on AAC devices and sign language, b) videos of caregivers using AAC and sign language, c) connection with other caregivers, d) access to SLPs who have experience with AAC, and e) the ability to ask questions to between sessions. 

Discussion: 
The purpose of this study is to determine caregivers’ preferences and needs regarding two key AAC intervention components: (a) service delivery (b) strategies to enhance treatment adherence. As this research is preliminary, specific conclusions cannot be drawn to directly answer these two questions. However, some pertinent themes have been collected during the interview coding process. These themes include common caregiver-identified barriers to successful AAC intervention implementation and intervention features that may support successful outcomes in the home environment. 

References
Baggett, K. M., Davis, B., Feil, E. G., Sheeber, L. L., Landry, S. H., Carta, J. J., & Leve, C. (2010). Technologies for Expanding the Reach of Evidence-Based Interventions: Preliminary Results for Promoting Social-Emotional Development in Early Childhood. Topics in Early Childhood Special Education, 29(4), 226–238. https://doi.org/10.1177/0271121409354782


Corbin, J., & Strauss, A. (2015). Basics of qualitative research. Sage.


Chung, Y. C., & Stoner, J. B. (2016). A meta-synthesis of team members' voices: What we need and what we do to support students who use AAC. Augmentative and alternative communication, 32(3), 175–186. https://doi.org/10.1080/07434618.2016.1213766


Creswell, J.W. and Poth, C.N. (2018). Qualitative inquiry and research design choosing among five approaches. (4th ed.) Sage.


Dada, S., Flores, C., Bastable, K., & Schlosser, R. W. (2021). The effects of augmentative and alternative communication interventions on the receptive language skills of children with developmental disabilities: A scoping review. International journal of speech-language pathology, 23(3), 247–257. https://doi.org/10.1080/17549507.2020.1797165


Drager, K., Light, J., & McNaughton, D. (2010). Effects of AAC interventions on communication and language for young children with complex communication needs. Journal of pediatric rehabilitation medicine, 3(4), 303–310. https://doi.org/10.3233/PRM-2010-0141


Glaser, B. G., & Strauss, A. (1967). The discovery of grounded theory: Strategies for qualitative research. Aldine.


Goldstein H. Where does social validity measurement fit into identifying and developing evidence based practices?, Communication Interventions for Individuals with Severe Disabilites: 
Exploring Research Challenges and Opportunities. Brookes; 2016:299-312.


Guralnick M. J. (2017). Early Intervention for Children with Intellectual Disabilities: An Update. Journal of applied research in intellectual disabilities: JARID, 30(2), 211–229. https://doi.org/10.1111/jar.12233


Light, J., & McNaughton, D. (2012). The changing face of augmentative and alternative communication: past, present, and future challenges. Augmentative and alternative communication, 28(4), 197–204. https://doi.org/10.3109/07434618.2012.737024


Light, J., McNaughton, D., & Caron, J. (2019). New and emerging AAC technology supports for children with complex communication needs and their communication partners: State of the science and future research directions. Augmentative and alternative communication, 35(1), 26–41. https://doi.org/10.1080/07434618.2018.1557251


O’Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014). Standards for reporting qualitative research: A synthesis of recommendations. Academic Medicine, 89(9), 1245. https://doi.org/10.1097/ACM.0000000000000388


QSR International Pty Ltd. (2021) NVivo (released in December 2021). https://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/home



Caregiver Preferences for Early AAC Intervention: Preliminary Themes and Reflections

Statement of Purpose: To instruct colleagues in a model of service delivery which utilizes interdisciplinary, neurodiverse team-teaching to decrease teacher burnout and increase positive outcomes for autistic high schoolers.
Summary: Widespread and pervasive barriers are currently keeping autistic and neurodivergent students from thriving in our public schools. For teachers and school-based speech pathologists currently serving autistic students there are methods that can be implemented immediately to have a measurable impact on the emotional and academic well-being of current students (Bottema-Beutel et al., 2020). These techniques can simultaneously create opportunities for educators to learn from each other and thus relieve the immense load of being a public school employee. Our primary purpose in presenting this information is to encourage attendees to consider adopting a co-teaching model with their special education colleagues, particularly between neurotypical and neurodivergent educators, specifically to support the well-being, confidence, and positive self-regard for their autistic students. The benefits of consistent, intentional relational support, the modeling of communication and collaboration, and the dual approaches of structured academic support and communication/self-advocacy interventions within a classroom setting provides a strong foundation for autistic students (Friend, et al.,2010). 
This presentation lays out a co-teaching model designed to support the development of positive self-image and self-advocacy skills within a neurodiversity-affirming space. The partnering of a special educator and a speech language pathologist is a perfect pairing to support students and provide a strong foundation of skills for success in school (Mentikoski, 2021). Providing explicit instruction in neurodivergence, fostering pride and acceptance in difference and neurodiversity, and supporting students with executive function strategies to apply directly to academic tasks provides students with the tools they need to venture out into the school environment with a strong affinity based community surrounding them. 
Additionally, having two responsive and engaged educators with different backgrounds and educational lenses gives an opportunity for authentic modeling of working relationships for students. Dividing time, teaching materials, content, and one-on-one support is a dynamic and sometimes challenging collaborative effort (Emmons & Zager, 2018). Autistic students benefit from seeing the work and reward that comes out of these partnerships.
Autistic high school students who have the support of two educators with a shared focus on creating a neurodivergent-affirming space and self advocacy, but with differing areas of expertise around academic support and facilitating cross-neurotype communication, have the widespread support they need to feel confident in engaging across a variety of academic environments. When students have the academic support they need, combined with direct instruction in their learning style and in self-advocacy, they make more academic and mental health gains (Sosnowy et al., 2019). The shared responsibility of creating lessons focusing on self-advocacy, executive functioning, and autistic pride means that teachers have more capacity to authentically build relationships with their students, and to do the kind of outreach and education to their general education colleagues needed in order to spread the principals of neurodiversity-affirming practices (Scheerer et al., 2022). 
Isolating the cause of student outcomes in a public school is impossible; there are too many variables to draw hard conclusions about interventions conducted as part of a comprehensive high school education. Anecdotally, however, it is clear that the co-teaching model implemented by the instructors is working: when surveyed about whether they want to continue on in the co-taught class, or move to a check-in model with a case manager, 80% of surveyed students elected to continue with the class.
5 minutes: Introductions
15 minutes: Presentation of relevant research to support the importance of neurodiversity-affirming approaches and co-teaching as beneficial for teachers and students.
10 minutes: Overview of co-teaching model application in a comprehensive high school learning center, including specific outline of how our system has developed, and the model within our school district.
15 minutes: Overview of lessons and structure for the year.
5 minutes: Reports/feedback from co-taught students.
10 minutes: Questions 

Axbey, H., Beckmann, N., Fletcher-Watson, S., Tullo, A., & Crompton, C. J. (2023). Innovation through neurodiversity: Diversity is beneficial. Autism, 0(0). https://doi.org/10.1177/13623613231158685: In a study measuring creativity, innovation, and consistency, neurodiverse groups (autistic and neurotypical people working together) and the most creative and innovative designs.

Bottema-Beutel, K., Cuda, J., Kim, S. Y., Crowley, S., & Scanlon, D. (2020). High School Experiences and Support Recommendations of Autistic Youth. Journal of autism and developmental disorders, 50(9), 3397–3412. https://doi.org/10.1007/s10803-019-04261-0: Recommendations include: providing personal attention, showing care, providing specially designed instruction, supporting kids’ ability to cope with school and stay regulated, and supporting social interaction. Additionally, educators need to intentionally affirm autistic identities and center individual strengths. 

Crompton, C. J., Ropar, D., Evans-Williams, C. V., Flynn, E. G., & Fletcher-Watson, S. (2020). Autistic peer-to-peer information transfer is highly effective. Autism, 24(7), 1704–1712. https://doi.org/10.1177/1362361320919286: In a study measuring effectiveness of peer-to-peer information transfer, autistic to autistic information transfer was as efficient as neurotypical to neurotypical information transfer.

Emmons, C. L., & Zager, D. (2018). Increasing Collaboration Self-Efficacy to Improve Educational Programming for Students With Autism. Focus on Autism and Other Developmental Disabilities, 33(2), 120–128. https://doi.org/10.1177/1088357616686312: Collaborative teaching increases capacity, feelings of success, and leverages resources for educators working with autistic students.

Friend, M., Cook, L., Hurley-Chamberlain, D., & SHamberger, C. (2010). Co-Teaching: An Illustration of the Complexity of Collaboration in Special Education. Journal of Educational and Psychological Consultation, 20(9), 9-27.


Hester, O.R., Bridges, S.A., & Rollins, L.H. (2020). ‘Overworked and Underappreciated’: Special Education Teachers Describe Stress and Attrition. Teacher Development, 24(3), 348-365, https://doi.org/10.1080/13664530.2020.1767189: Special education teachers feel unsupported by administrators and feel that teaching has a negative impact on their overall quality of life. 

Mentikoski, C. (2021, January 12). Why-and How-Co-Teaching Works for Me. AshaWire. https://leader.pubs.asha.org/do/10.1044/leader.SCM.26012021.34/full/

Scheerer, N.E., Boucher, T.Q., Sasson, N.J., & Iarocci, G. (2022). Effects of an Educational Presentation About Autism High School Students’ Perceptions of Autistic Adults. Autism In Adulthood, 4(3), https://doi.org/10.1089/aut.2021.0046: A short educational presentation about autism negated some of the negative perceptions held by neurotypical high schoolers about autistic adults.

Sosnowy, C., Silverman, C., Shattuck, P., & Garfield, T. (2019). Setbacks and Successes: How Young Adults on the Autism Spectrum Seek Friendship. Autism in adulthood : challenges and management, 1(1), 44–51. https://doi.org/10.1089/aut.2018.0009: Autistic students have the most success in developing authentic relationships when their autistic traits are normalized. This acceptance is most often found with other neurodivergent youth. 

Strogilos, V., King-Sears, M.E., Tragoulia, E., Voulagka, A., & Stefanidis, A. (2023). A meta-synthesis of co-teaching students with and without disabilities. Educational Research Review, 38. https://doi.org/10.1016/j.edurev.2022.100504: Co-teachers believe that co-teaching is beneficial for learning for both teachers and students. 


Supporting the Success of Autistic Students Through a Co-Teaching Model

Approximately 48% of children receiving special education services from birth to 3 years are from minoritized linguistic backgrounds (US Department of Education, 2022). However, this rich linguistic diversity is not well recognized; children from non-English speaking backgrounds are frequently misdiagnosed for special education services. Although this disproportionality was first documented at least 55 years ago (Dunn, 1968) and well-studied since then (e.g., Zuckerman et al., 2014), misdiagnosis of linguistically diverse children continues to be a persistent concern. 

One major cause of the lack of linguistic responsivity is the absence of knowledge, tools, and sufficient training (Caesar & Kohler, 2007). Studies reviewing medical records have shown that special education practitioners serving children from birth to 3 are not reliably documenting language histories or employing proper assessment tools for linguistically diverse children (e.g., Huerta et al., 2021). Practitioners report poor guidance on whether to assess and treat in one or more languages. Moreover, language access for the children’s families through the use of interpreters is often not considered (Saenz et al., 2019). Despite years of research, the issue remains largely unresolved (Arham et al. 2021).  

These challenges with services for culturally linguistically diverse populations necessitate the development of a protocol that streamlines and interprets best-practice procedures, many of which already exist but are not well implemented and disseminated. The presentation aims to summarize the Linguistic Diversity Protocol (LDP) created for practitioners as an attempt to respond to linguistic diversity during assessment.  The presentation will also detail the components of LDP and the significance of using linguistic responsive procedures during assessment. 

The Language Development Protocol (LDP) is a training protocol created through input from subject matter experts and practitioners who work with linguistically diverse populations aged from birth to three years. The protocol's framework is an adaptation of special education teacher training models and is based on evidence-based practices. The development of the training outline is based on feedback from the community practitioners through surveys, focus groups and panel discussions. It is an attempt to create and implement one of the many ways to resolve the concern of misdiagnosis in children with linguistically diverse backgrounds. 

The presentation will describe the challenges encountered by practitioners due to the lack of linguistically responsive assessments and present the LDP as a case study of a researcher-practitioner collaboration that aims to provide a tool for implementation in practice. We will also provide recommendations and future directions for practitioners interested in implementing linguistically responsive practices. Additionally, the presentation will also provide guidance for professionals to develop similar protocols with their teams. Specifically, the presentation will summarize the approaches for enhancing linguistic responsivity in assessments and analyze different methods for providing language access, (e.g., the use of language translators and interpreters). The presentation will conclude with a discussion of obstacles to implementing linguistically responsive practices and proposing solutions to overcome them. 


Time –Ordered Agenda – Oral presentation (60 min) 

3 minutes – Introductions and disclosures 

10 minutes – Overview of literature and challenges in linguistic responsivity 

5 minutes – Overview of LDP 

10 minutes – Constructs of LDP / strategies for linguistic responsiveness during assessment 

10 minutes – Language access during assessments 

10 minutes – Future directions and clinical recommendations 

12 minutes – Question and answer 

References

Caesar, L. G., & Kohler, P. D. (2007). The state of school-based bilingual assessment: Actual practice versus recommended guidelines. 
https://doi.org/10.1044/0161-1461(2007/020) 

Dunn, L. M. (1968). Special education for the mildly retarded—Is much of it justifiable?. Exceptional children, 35(1), 5-22. 
https://doi.org/10.1177/0014402968035001 

Huerta, L., Cycyk, L. M., Sanford-Keller, H., Busch, A., Dolata, J., Moore, H., ... & Zuckerman, K. (2021). A retrospective review of communication evaluation practices of young Latinx children. Journal of Early Intervention, 43(4), 295-313. 
DOI: 10.1177/10538151211012703 

Saenz, T. I., & Langdon, H. W. (2019). Speech-language pathologists' collaboration with interpreters: Results of a current survey in California. Translation & Interpreting, The, 11(1), 43-62. 

US Department of Education, 2022. IDEA section 618 Data. 
https://data.ed.gov/dataset/docs/idea-section-618-data-products-state-level-data-files 


Zuckerman, K. E., Mattox, K. M., Sinche, B. K., Blaschke, G. S., & Bethell, C. (2014). Racial, ethnic, and language disparities in early childhood developmental/behavioral evaluations: A narrative review. Clinical pediatrics, 53(7), 619-631. 
DOI: 10.1177/0009922813501378 



Assessment in Early Intervention: Developing the Linguistic Diversity Protocol

"PROMPTs for Restructuring Oral Muscular Phonetic Targets (PROMPT) is a philosophy, approach, system and technique that helps clients improve functional communication. The purpose of this presentation is to demonstrate how PROMPT is a whole-child approach that provides an evidenced-based framework and skills to carefully assess and treat clients. It is based on the Conceptual Framework (CF), which is comprised of three domains: Physical-Sensory, Cognitive-Linguistic, and Social-Emotional. It takes into consideration how children understand and use language, socially interact with others and how their articulators move during speech production. It approaches communication breakdowns across these domains in order to find ways to utilize the child’s strengths to maximize potential for functional interaction. 

The CF is grounded in Dynamic Systems Theory and within each domain several critical theories guide decision making, further demonstrating this whole-child approach (Thelen, E.) The Physical-Sensory Domain is guided by the Neuronal Group Selection (Sporns, O. et al., Kaas, J.H.), Functional Synergies (Green, J.R. et al.) and Motor Learning Theory (Maas, E. et al.) (Schmidt, R.A.). The Cognitive Linguistic Domain is grounded in Cognitive Schema (Piaget, J.), Event Knowledge (Nelson, K.) and Competition Model Theory (Bates, E. et al.) (Bloom, L.). The Social-Emotional Domain is supported by Social Development (Vygotsky, L.S.) and Social Pragmatic Theory (Prizant, B. et al.) (Wetherby, A.).      
 
When PROMPT is implemented, several procedures are completed. The child is systematically evaluated via the Global Domain Evaluation (GDE), System Analysis Observation (SAO) and Motor Speech Hierarchy (MSH). Therefore, PROMPT not only addresses “speech”, it addresses the whole-child. It helps the clinician plan and organize the direction and type of individualized treatment needed. In addition, it provides kinesthetic, proprioceptive, auditory and visual feedback to the speech subsystem. This feedback is comprised of four different levels of PROMPT technique. Technique can be used to support the child’s Physical-Sensory, Cognitive-Linguistic, and Social-Emotional Domains (Hayden, D. et al.). 
 
Numerous efficacy studies have been conducted, which support the effectiveness of PROMPT. Speech assessment and brain MRIs were performed pre- and post-treatment in the Neural Changes Induced by a Speech Motor Treatment in Childhood Apraxia of Speech: A Case Series (Fiori et al.) study. Results indicated children with CAS who received PROMPT treatment showed more marked effects on speech motor control and related connectivity compared with nonspeech oral motor treatment. Another study conducted using MRI technology, Cortical Thickness in Children Receiving Intensive Therapy for Apraxia of Speech (Kadis et al.), discovered MRI’s in children with CAS had significantly thicker Left Posterior Superior Temporal Gyrus (LPSTG). After PROMPT Therapy, significant thinning of the LPSTG was evident and intelligibility improvements were noted. This was the first study to show experience related structural plasticity after therapy for speech sound disorders. PROMPT Intervention for Children with Severe Speech Motor Delay: A Randomized Control Trial (Namasivayam et al.), evidenced that PROMPT intervention is a clinically effective intervention approach for children with speech motor disorders. Notable improvements in speech motor control, speech articulation, and word-level speech intelligibility were identified. Treating Speech Subsystems in CAS with Tactual Input: The PROMPT Approach (Dale et al.), showed that PROMPT assessment and treatment has also demonstrated to be effective amongst children with apraxia. Results of this study indicated that even the children who did not receive tactile input with PROMPT technique, for the full eight weeks, made significant improvements with motor speech control. These results indicate PROMPT is efficacious without tactile input, which supports the use of PROMPT in teletherapy. Kinematic Changes in Jaw and Lip Control of Children with Cerebral Palsy Following Participation in a Motor-Speech (PROMPT) Intervention, suggested movement changes in response to PROMPT therapy. These improvements in movement resulted in significantly improved speech perception (Ward, R. et al.).  
 
In summary, Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) is a whole-child approach that provides an evidenced-based framework and skills to carefully assess and treat clients’ Physical-Sensory, Cognitive-Linguistic and Social Emotional Domains. This interactive presentation will be comprised of videos that show clinical examples of PROMPT assessment and treatment to improve functional communication.

References:
Dale, P., & Hayden, D. (2013). Treating speech subsystems in CAS with tactual input: The 
PROMPT approach. American Journal of Speech Language Pathology, 4, 644-661.

Fiori, S., Pannek, K., Podda, I., Cipriani, P., Lorenzoni, V., Franchi, B., Pasquariello, R., Guzzetta, A., Cioni, G., & Chilosi, A. (2021). Neural Changes Induced by a Speech Motor Treatment in Childhood Apraxia of Speech: A Case Series. Journal of Child Neurology.
 
Hayden, D., Namasivayam, A. K., & Ward, R., Eigen, J., & Clark, A. (2020). The PROMPT approach: Theory, Evidence, Use and Application. In L. Williams, S. McLeod, & R.  McCauley (Eds.), Interventions for Speech Sound Disorders (pp. 477-504). Second Edition, Baltimore, Maryland: Brookes Publishing.

Kadis, D. S., Goshulak, D., Namasivayam, A., Pukonen, M., Kroll, R., De Nil, L. F., Pang, E. W., & Lerch, J. P. (2013, in press).  Cortical thickness in children receiving intensive therapy for idiopathic apraxia of speech. Brain Topography, 27:240–247.
Maas, E., Robin, D.A., Austermann Hula, S.N., Freedman, S.E., Wulf, G., Ballard, K.J., & Schmidt, R.A., (2008).  Principles of motor learning in treatment of motor speech disorders.  American Journal of Speech-Language Pathology, 17, 277-298.

Namasivayam, A.K., Huynh, A., Granata, F. et al. PROMPT Intervention for Children with Severe Speech Motor Delay: a Randomized Control Trial. Ped. Research (2020). 

Namasivayam, A. K., Pukonen, M., Goshulak, D., Yu.V.Y., Kadis, D.S., Kroll, R., Pang, E.W., & 
De Nil, L.F. (2013). Changes in speech intelligibility following motor speech treatment in 
children. Journal of Communication Disorders, 46(3):264-80.

Ward, R., Strauss, G., & Leitão, S. (2013). Kinematic changes in jaw and lip control of children 
with cerebral palsy following participation in a motor-speech (PROMPT) intervention. 
International Journal of Speech-Language Pathology, 15 (2): 136-155.


Agenda
•	10 minutes - Introductions and Disclosures
•	20 minutes - Overview: Conceptual Framework (Physical, Cognitive, Social Domains)
•	15 minutes - Key Components of Assessment
•	15 minutes - Key Components of Treatment
•	40 minutes - Clinical application, case examples and discussion
•	10 minutes - Summary: What makes PROMPT a whole-child approach
•	10 minutes - Conclusion, Question and Answers

PROMPT: A Whole Child Approach

The American Speech-Language-Hearing Association (ASHA) has identified the ability to work as part of an interprofessional (IPE) team as an essential skill for speech-language pathologists (ASHA, n.d.). Therefore, interprofessional education is a vital component of graduate education programs in the fields of communication sciences and disorders. 

Cleveland State University (CSU) has an established multi-semester interprofessional education course that is taught collaboratively by members of several programs within the College of Health. Students participate in didactic sessions, interactive simulations of patient care situations, and debriefing opportunities with peers and instructors. Currently, there is no direct co-treatment component in this course sequence. 

This IPE collaboration provides an opportunity for students to learn to work within their own professional scope of practice while collaborating to help clients improve communication outcomes. Successful collaborations between music therapy and speech-language pathology clinicians have been documented (Johnson, 2019). Clinical methodology was built upon existing research literature that documents neural relationships between speech, language, and music (Hurkmans et al., 2012; Hurkmans et al., 2015). 

The collaborative interprofessional team, composed of faculty from the Communication Sciences and Disorders (CSD) Department and the Music Therapy (MT) Department, was established at CSU in 2020 to bridge interprofessional education in the classroom with applied practice in the clinical setting. 

Graduate student clinicians learn to work together using various styles of collaboration (awareness, consultation, direct co-treatment). Under the direction of licensed faculty, graduate student clinicians provide supervised clinical services within the university clinic setting. 

This collaborative model includes strategic selection of clients, assignment of student clinicians, advance preparation of students and clients, education regarding scope-of-practice, establishment of roles and boundaries, co-treatment sessions with direct collaboration, periodic supervised interprofessional debriefings, and a final exit meeting at the conclusion of the semester. 

Positive learning outcomes have been documented by the interprofessional clinical education team. Students gain knowledge regarding scope of practice and professional boundaries, developing a deepened understanding of, and respect for, their interdisciplinary colleagues across the graduate programs. Prior to this collaboration, many students have experienced only limited interaction with students from other disciplines in the classroom setting. Working together toward a common goal of treating a real-life client with a communication disorder facilitates development of authentic rapport among the graduate student clinicians. 

Additionally, speech-language pathology students are able to apply evidence-based clinical concepts learned in the interprofessional classroom. Music therapy students, as well, prescriptively apply music-based strategies featuring the elements of music which have been taught in their curriculum. The involvement of a co-treatment partner allows opportunities for meaningful discussion regarding theory behind each evidence-based intervention procedure and/or client education approach selected for the individual client. Providing an explanation of rationale for a graduate student of a different discipline is a novel opportunity to consider the concept from a unique perspective. For example, students in this collaboration have explored how the manipulation of various musical elements by the music therapy clinician may influence a client’s ability to produce a specific sound sequence, word, or phrase within a therapy task. Questions posed by the speech-language pathology student have developed into a rich student-led conversation comparing and contrasting the clinical decision-making perspectives of the two disciplines. This authentic and dynamic professional dialogue is a key element that differentiates a didactic IPE course from an interprofessional clinical education model involving direct supervision. 

This interprofessional collaborative model may provide a framework to assist clinical educators in training music therapy and speech-language pathology graduate student clinicians. Both speech-language pathology and music therapy students have shared that this collaborative experience has opened new avenues of clinical understanding and deepened respect for interprofessional colleagues. A positive interprofessional clinical experience in the graduate programming lays foundational groundwork to ensure that this type of interprofessional collaboration is successfully implemented in the field of communication disorders.

References/Citations

American Speech-Language-Hearing Association. (n.d.). Interprofessional Education/Interprofessional Practice (IPE/IPP).ASHA.org. https://www.asha.org/Practice/Interprofessional-Education-Practice/Hanson-

Abromeit, D. (2015). A conceptual methodology to define the therapeutic function of music. Music TherapyPerspectives, 33(1), 25-38.

Hurkmans, J., de Bruijn, M., Boonstra, A. M., Jonkers, R., Bastiaanse, R., Arendzen, H., & Reinders-Messelink, H. A.(2012). Music in the treatment of neurological language and speech disorders: A systematic review. Aphasiology, 26(1), 1-19. doi:10.1080/02687038.2011.602514

Hurkmans, J., Jonkers, R., de Bruijn, M., Boonstra, A. M., Hartman, P. P., Arendzen, H., & Reinders-Messelink, H. A.(2015). The effectiveness of speech-music therapy for aphasia (SMTA) in five speakers with apraxia of speech and aphasia.Aphasiology, 29(8), 939-964. doi:10.1080/02687038.2015.1006565.

Johnson, M. A., Coles, H., Keough, L., King, B., & Reed, M. (2019). Co-delivered integrative music and language therapy: Positive outcomes through music therapy and speech-language pathology collaboration. Perspectives of the ASHA Special Interest Groups, 4(2), 261-268.

King, B., Keough, L., Johnson, M., Coles, H, & Reed, M. (2021, October 15-17). Co-delivered integrative music and language therapy [Conference presentation]. AMTA 2021 Conference, Virtual. 

Koole, H., Oommen, E., & Woude, J. V. (2019, July 25). The importance of building system-wide capacity for Interprofessional Education. ASHA Journals Academy. Retrieved April 5, 2022, from https://academy.pubs.asha.org/2019/08/the-importance-of-building-system-wide-capacity-for-interprofessional-education/ 

Reeves, S., Fletcher, S., Barr, H., Birch, I, Boet, S., Davies, N., . . . Kitto, S. (2016). A BEME systematic review of the effectsof interprofessional education: BEME Guide No. 39. Medical Teacher, 38, 656–668.https://doi.org/10.3109/0142159X.2016.1173663

Zhang, J.W., DeDe, G, Magee, W., Marjoram, C., Schoolar, K., & Zhang, Y. (2021, October 15-17). An interdisciplinary music therapy fieldwork program for people with aphasia [Conference presentation]. AMTA 2021 Conference, Virtual.

Time-Ordered Agenda

0:00-5:00 Introductions, Disclosures, Learning Objectives 

5:00-10:00 Interprofessional Collaborative Formats 

10:00-15:00 History and Rationale 

15:00-20:00 Interprofessional Education at CSU 

20:00-25:00 The SLP/MT Collaborative Model at CSU: Overview 

25:00-27:00 Client Selection 

27:00-29:00 Student Clinician Selection 

29:00-31:00 Preparation 

31:00-33:00 Establishment of Roles 

33:00-35:00 Additive Treatment Process 

35:00-37:00 Direct Collaboration in Therapy Sessions 

37:00-39:00 Debriefing 

39:00-41:00 Feedback 

41:00-47:00 Results 

47:00-52:00 Challenges 

52:00-55:00 Future Directions 

55:00-57:00 Key Features of Collaborative Model 

57:00-60:00 Q&A

Premium content

Downloads

Next from OSHA 2023

Telepractice Group Therapy for Stuttering with Adolescents

Similar lecture

Learning Co-Speech Gesture for Multimodal Aphasia Type Detection