Use of the ICF for clinical practice in speech-language pathology

The World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF) (WHO, ) states that one of its five possible applications is for clinical use. The ICF is both a conceptual framework and a classification system with a complex numerical coding system and operational definitions. Thus, the practical and useful application of the classification system for recording assessment results could prove difficult. However, an agreed upon clinical interpretation of the ICF by clinicians is essential for it to be able to communicate complex clinical assessments to other professionals, third party payers, administrators, health care policy makers, and the consumers of our services. The American Psychological Association and the World Health Organization are working on finalizing the Procedural Manual and Guide for the Standardized Application of the ICF: A Manual for Health Professionals. This Procedural Manual is being designed to provide health professionals with directions for clinical use of the ICF, including additional information about the clinical interpretation of each code, to facilitate reliable and valid clinical use of the ICF. This article addresses issues discussed in the Procedural Manual and a range of complex issues regarding the clinical use of the ICF by speech-language pathologists.     

Global citizenship: Defining capabilities for speech-language pathology

Abstract

Purpose: This paper outlines the findings of a scoping review of the literature relating to global citizenship. The purpose of the review was to develop a working definition and associated capabilities for assessing global citizenship among speech-language pathologists (SLPs), which may also prove helpful to other health professionals and for educating tertiary students.

Method: Using Arksey and O'Malley's scoping review framework, key databases were searched, namely Medline, CINAHL, PsycINFO, the Cochrane Library and Google Scholar. Subsequently the Medical Subject Heading (MeSH) terms were applied for coding and categorising initial research findings. Articles were individually appraised using the Critical Appraisal Skills Programme tool (CASP).

Result: Of the 2126 articles identified, 21 articles were determined to satisfy the search criteria. The literature revealed nine capabilities associated with global citizenship appropriate for health professionals including SLPs.

Conclusion: Based on the findings, a working definition is determined for assessing professional global citizenship capabilities, which will prove useful for improving occupational standards, for charting competencies, and ultimately enhancing professional capability.     

Children's views of communication and speech-language pathology

Children have the right to express their views and influence decisions in matters that affect them. Yet decisions regarding speech-language pathology are often made on their behalf, and research into the perspectives of children who receive speech-language pathology intervention is currently limited. This paper reports a qualitative study which explored experiences of communication and of speech-language pathology from the perspectives of children with speech, language, and communication needs (SLCN). The aim was to explore their perspectives of communication, communication impairment, and assistance. Eleven school-children participated in the study, aged between 7–10 years. They were recruited through a speech-language pathology service in south west England, to include a range of ages and severity of difficulties. The study used open-ended interviews within which non-verbal activities such as drawing, taking photographs, and compiling a scrapbook were used to create a context for supported conversations. Findings were analysed according to the principles of grounded theory. Three ways of talking about communication emerged. These were in terms of impairment, learning, and behaviour. Findings offer insight into dialogue between children with SLCN and adults; the way communication is talked about has implications for children's view of themselves, their skills, and their participation.     

Assessment of student competency in a simulated speech-language pathology clinical placement

Abstract

Clinical education programs in speech-language pathology enable the transition of students’ knowledge and skills from the classroom to the workplace. Simulated clinical learning experiences provide an opportunity to address the competency development of novice students. This study reports on the validation of an assessment tool designed to evaluate speech-language pathology students’ performance in a simulated clinical placement. The Assessment of Foundation Clinical Skills (AFCS) was designed to link to concepts and content of COMPASS^®: Competency Assessment in Speech Pathology, a validated assessment of performance in the workplace. It incorporates units and elements of competency relevant to the placement. The validity of the AFCS was statistically investigated using Rasch analysis. Participants were 18 clinical educators and 130 speech-language pathology students undertaking the placement. Preliminary results support the validity of the AFCS as an assessment of foundation clinical skills of students in this simulated clinical placement. All units of competency and the majority of elements were relevant and representative of these skills. The use of a visual analogue scale which included a pre-Novice level to rate students’ performance on units of competency was supported. This research provides guidance for development of quality assessments of performance in simulated placements.     

The use of the ICF in speech-language pathology research: Towards a research agenda

The International Classification of Functioning, Disability and Health (ICF) facilitates a wide range of research in speech-language pathology. In addition to framing the development of assessment tools and evaluating interventions, the ICF can also be used to evaluate concepts such as third party disability or environmental factors that prevent or facilitate communication accessibility. In this paper, a model proposed by Stucki and Grimby is used to describe research on a continuum from basic to professional, and from cell to society. We translate this model to speech-language pathology by using examples from our programme of research in the Communication Disability Centre. The model also allows the identification of broad gaps in speech-language pathology research to date. The paper concludes with recommendations for a research agenda for the ICF in speech-language pathology. In particular, it is argued that unless speech-language pathology researchers fully understand the constructs of the ICF as applied to communication disability, valid measures for professional practice research cannot be developed.     

Assessing and developing the written reflective practice skills of speech-language pathology students

Purpose: Written reflective practice aims to support critical thinking and problem solving skills in speech-language pathology (SLP) clinical education programmes. Yet, there has been limited investigation of students’ development of written reflective practice skills over time and during a real-time clinical experience. The purpose of this study was to investigate students’ development of breadth and depth of written reflective practice across a six-week clinical experience.

Method: Participants were 59 undergraduate and 14 postgraduate SLP students. Participants wrote critical reflections describing an interaction with a client/s at the conclusion of weeks two, four and six of their clinical experience. Formative feedback was provided after each submission. Breadth and depth of reflection were coded using a modification of Plack et al.’s coding schema.

Result: There was a statistically significant association between time and likelihood of development of breadth of reflection for the elements process and content. Depth of reflection improved significantly across time. The majority of participants were classified as "reflectors" or critical reflector at the conclusion of the study.

Conclusion: SLP students can make significant improvements in both breadth and depth of written reflective practice over a six-week period. Implications for clinical teaching are discussed.     

Reflective practice in speech-language pathology: A scoping review

Abstract

Purpose: Within the profession of speech-language pathology, there is limited information related to both conceptual and empirical perspectives of reflective practice. This review considers the key concepts and approaches to reflection and reflective practice that have been published in the speech-language pathology literature in order to identify potential research gaps.

Method: A scoping review was conducted using Arksey and O’Malley's (2005) Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8, 19–32.[Taylor & Francis Online] , [Google Scholar] framework.

Result: A total of 42 relevant publications were selected for review. The resulting literature mapping revealed that scholarship on reflection and reflective practice in speech-language pathology is limited. Our conceptual mapping pointed to the use of both multiple and generic terms and a lack of conceptual clarity about reflection and reflective practice in speech-language pathology. Two predominant approaches to reflection and reflective practice were identified: written reflection and reflective discussion. Both educational and clinical practice contexts were associated with reflection and reflective practice. Publications reviewed were primarily concerned with reflection and reflective practice by novices and expert practitioners.

Conclusion: Based on this review, we posit that there is considerable need for conceptual and empirical work with a goal to support university- and work-based educational initiatives involving reflection and reflective practice in speech-language pathology.     

A family-centred model of care in paediatric speech-language pathology

Abstract

Developments in paediatric models of care support family-centred practice (FCP); however, there is limited evidence for its use in speech-language pathology. This randomized controlled study examined whether parent satisfaction with FCP (n = 10) was greater than with usual practice (UP; n = 10) over 14 weeks for children with mild–moderate speech and/or language disorders. The FCP included parental goal decision-making; greater parent responsibility for clinic therapy tasks; and two home visits. There was a non-significant trend for the FCP group to have a higher mean score for the “Providing specific information” scale of the Measures of Process of Care. Goals for the FCP and UP groups were respectively targeted towards the Activities and Participation or the Body Function components of the International Classification of Functioning, Disability and Health–Children and Youth. While there were no significant differences between groups for speech/language outcomes post-intervention; it is clinically interesting that more children in the FCP group improved on the Renfrew Action Picture Test than the UP group. This study did not demonstrate a significant benefit for FCP over a relatively short timeframe in a small sample of children. Further research is warranted to determine if there is evidence for the use of FCP in speech-language pathology.     

Comparing alternate learning pathways within a problem-based learning speech-language pathology curriculum

Purpose: This qualitative study investigated the learning process for speech-language pathology (SLP) students engaging in a problem-based learning (PBL) curriculum and compared the perspectives of students from two pathways.

Method: Sixteen final-year SLP students participated in one of four focus groups. Half the participants entered the course directly via an undergraduate pathway and the other half entered via a graduate entry pathway. Each focus group comprised two students from each pathway. Data were generated via a semi-structured interview and analysed thematically.

Result: Regardless of participants’ pathway, many similar themes about factors that influenced their expectations prior to PBL commencing as well as their actual PBL experiences were raised. Participants believed that PBL was a productive way to learn and to develop clinical competencies. Many were critical of variations in PBL facilitation styles and were sensitive to changes in facilitators. The majority of participants viewed experiential opportunities to engage in PBL prior to commencement of semester as advantageous.

Conclusion: Combining students with different backgrounds has many advantages to the PBL learning process. Regardless of prior experiences, all students must be sufficiently prepared. Furthermore, the facilitator has a crucial role with the potential to optimise or detract from the learning experience.     

The role of speech-language pathologists in adult palliative care

Purpose: Given minimal studies describing the role and practice of speech-language pathologists (SLPs) in adult palliative care, the aim of this review was to compile a database of research literature, examine the potential research gaps and to consider material that specifically discussed the need for and/or use of procedures and protocols for SLPs working in palliative care that would support the development of SLP palliative care guidelines.

Method: A scoping review was conducted utilising Arksey and O’Malley’s framework with the goal of exploring any key concepts and approaches utilised by SLPs in adult palliative care, plus any literature and/or recommendations regarding SLP practice in adult palliative care settings.

Result: Over 1200 articles were initially identified. Of the 1200 articles, 13 academic papers were considered relevant as they recommended, or at least suggested, the need for speech-language pathology therapy guidelines to be implemented within adult palliative care settings.

Conclusion: The main focus of these articles was on ethical considerations and clinical recommendations for SLPs. Recommendations arising from this scoping review include providing goals to support current practising SLP clinicians and developing clinical guidelines to manage swallowing and/or communication needs of people receiving palliative care.     

The ICF Activities and Participation related to speech-language pathology

Increasingly speech-language pathologists are considering the effects of a client's communication and/or swallowing disability on the client's day to day life. The activities and life situations that make up a person's everyday life are described in the Activities and Participation component of the World Health Organization's International Classification of Functioning, Disability and Health (ICF). This paper describes the Activities and Participation component of the ICF and how communication is currently represented in this component. This paper then explores the current debate between the concepts of activities and participation and how this can continue to inform and develop our understanding of communication activity and communication participation into the future.     

A review of standardized patients in clinical education: Implications for speech-language pathology programs

The use of standardized patients has been reported as a viable addition to traditional models of professional practice education in medicine, nursing and allied health programs. Educational programs rely on the inclusion of work-integrated learning components in order to graduate competent practitioners. Allied health programs world-wide have reported increasing difficulty in attaining sufficient traditional placements for students within the workplace. In response to this, allied health professionals are challenged to be innovative and problem-solving in the development and maintenance of clinical education placements and to consider potential alternative learning opportunities for students. Whilst there is a bank of literature describing the use of standardized patients in medicine and nursing, reports of its use in speech-language pathology clinical education are limited. Therefore, this paper aims to (1) provide a review of literature reporting on the use of standardized patients within medical and allied health professions with particular reference to use in speech-language pathology, (2) discuss methodological and practical issues involved in establishing and maintaining a standardized patient program and (3) identify future directions for research and clinical programs using standardized patients to build foundation clinical skills such as communication, interpersonal interaction and interviewing.     

Optimal intervention intensity in speech-language pathology: Discoveries,challenges, and unchartered territories

Abstract

This article is the final response in a scientific forum on the optimal intensity of intervention in speech-language pathology. It is a reflection on the state of knowledge offered by the 13 commentaries in this issue, addressing the areas of early communication and language impairment, speech sound disorders in children, emergent literacy, reading, aphasia, dysphagia, stuttering, motor speech disorders, voice disorders, and traumatic brain injury. Although more intense intervention can lead to better outcomes, the relationship between intensity and outcome is not always linear. More is not always better. Non-intense and intense schedules can yield similar outcomes. Intensity can also reach a point of diminishing return. The insights offered by the authors illustrate the challenges involved in studying this complex issue. To establish the optimal intensity of interventions in speech-language pathology our field needs to: identify active ingredients of interventions; better understand how principles of motor learning and neural plasticity facilitate learning; appreciate the contribution of individuals characteristics, values, and preferences; discover the effect of specific combinations of intensity (including dose, dose form, dose frequency, session duration, and total intervention duration) on treatment outcomes, and find practical solutions when disparities exist between research recommendations and workplace limitations.     

The ICF Body Functions and Structures related to speech-language pathology

Body Functions and Body Structures form one component of the International Classification of Functioning, Disability and Health (ICF). Coding of items within these ICF chapters can be useful in speech-language pathology to provide a holistic overview of an individual's condition, but only if this component is considered alongside the other components that make up the ICF. This paper outlines the Body Functions and Body Structures codes that are most relevant to speech-language pathology and discusses the overlap that occurs with the Activities and Participation component. A review of the strengths and limitations of the ICF Body Structures and Body Functions components is also presented.     

An investigation of equity of rural speech-language pathology services for children: A geographic perspective

The World Health Organization's equity objective states that there should be equal access to healthcare for equal need, regardless of location. Disparities between health services and challenges to achieving the equity objective have been documented both in Australia and around the world. However, little is known about the extent to which this objective has been met in the field of speech-language pathology in Australia. This study used structured interviews with 74 speech-language pathologists working in rural areas of New South Wales and Victoria. The data obtained were used to develop maps to describe the availability of paediatric speech-language pathology services through consideration of location and frequency. The findings show that 98.60% of localities are unserviced at the ideal frequency of weekly or more often. It is important to note that these percentages include all localities in the represented rural areas of New South Wales and Victoria, some of which are minimally populated. The maps also depict travel and distance as barriers to the accessibility of services and have been used to suggest a critical maximum distance for paediatric outpatient speech-language pathology services in rural New South Wales and Victoria. From the data collected, 50 kilometres was suggested as the critical maximum distance past which consumers become unable or unwilling to travel to access weekly rural speech-language pathology services in rural New South Wales and Victoria. Thus, people living in almost one third of rural localities in rural New South Wales and Victoria lie beyond what is considered by rural speech-language pathologists to be a reasonable travel distance to weekly speech-language pathology services. These results highlight barriers to the achievement of equitable services in rural areas. The results also provide an essential foundation to inform policy development and assist health service planning to meet the needs of rural consumers.     

The ICF Contextual Factors related to speech-language pathology

The World Health Organization's International Classification of Functioning, Disability and Health (ICF) conceptualizes functioning and disability as a dynamic interaction between a person's health condition and their contextual factors. Contextual factors “represent the complete background of an individual's life and living” and comprise two components: Environmental Factors and Personal Factors. This review aims to: (1) discuss why contextual factors are important for speech-language pathologists to address in their clinical practice, (2) describe how environmental factors are coded in the ICF, (3) identify environmental factors that are relevant for people with communication disorders, and (4) identify personal factors that are relevant for people with communication disorders. Research on environmental factors that can influence the functioning of individuals with various communication disorders is presented, in addition to studies on personal factors that are important for speech-language pathologists to consider. The paper concludes that speech-language pathologists need to address contextual factors routinely, in order to provide a holistic approach to intervention for their clients. Furthermore, although a number of contextual factors that are relevant for people with communication disorders have been reported in the literature, more research is needed in this area.     

Factors contributing to the brain drain in speech-language pathology: A New Zealand example

The aim of this research was to determine what attracts students to speech-language pathology (SLP), and the influence of intrinsic and extrinsic factors on two types of “brain drain” in SLP: emigration and career shift. Fifty undergraduate students and 13 recent graduates completed a questionnaire that tapped three main areas, level of student debt, intentions to emigrate, and career intentions. Ninety-seven per cent of respondents were female, with a median age of 25 years. Most SLP students and graduates had high levels of debt on graduation. Debt contributed to levels of worry and the ability to participate in education. However, debt alone did not influence career choice or long-term career planning. Over half of the respondents intended to leave New Zealand within 2 years of graduation, citing salary, travel, and training opportunities as factors. Incentives to remain in the profession included increased salary, more training opportunities, and student debt repayment. SLP students' career decisions were mainly influenced by interest in the profession. The conclusion was that three main factors need to be explored in an effort to increase the likelihood that SLPs remain in New Zealand: salary levels, increased training opportunities, and contributions to reduce student debt.