JCPSLP Vol 22 No 2 2020

Observations of children at mealtimes, interacting with their parents and siblings at home, at early childhood education, and during day-to-day activities (e.g., swimming lessons) provide unique insights not available in the clinical setting (Cronin, Verdon et al., 2020). Observations can be undertaken in person, via telehealth, or if families provide a video recording. One of the findings of the Toddlers with Cleft Palate Study was the variability in the children’s communication between settings and the different perceptions of their communicative competence between reporters (Cronin et al., 2020b) (Table 2). Observations are needed to identify the (sometimes subtle) differences in the speech, language, velopharyngeal function and feeding skills of toddlers with CP±L (Cronin et al., 2020b). Ideally, recording the children’s speech over time will provide insights about their speech development, whether it is an audio only recording, or video with lapel microphone used. Gauging assent to observe and make recordings with these young toddlers promoted their rights and required monitoring of their non-verbal communication and willingness to participate (Dockett & Perry, 2011). The child in Figure 1 provided her assent to be videoed by using the researcher’s camera tripod in her play and by inviting the researcher to help her organise her toys to be videoed.

Box 1. Sophia

Case history interviews may be supplemented with parent questionnaires or interviews, depending on time constraints and the reasons the children have been referred for speech-language pathology intervention. For example, the Intelligibility in Context Scale (ICS; McLeod, Harrison, & McCormack, 2012), the FOCUS: Focus on the Outcomes of Communication Under Six (Thomas-Stonell et al., 2012), and the Speech Participation and Activity Assessment of Children (SPAA-C; McLeod, 2004) provide more information about the children’s activities and participation, can guide choice of subsequent assessments, and assist SLPs to triangulate observations and assessment results to gather a fuller picture of the child’s functioning (Cronin et al., 2020b). Observations from a participant-observer A key component of ethnography is to act as a participant- observer, to understand a culture or context from the perspective of people within that culture (Howe et al., 2019). It involves immersing oneself in the culture and collecting observations and artefacts to understand the everyday life in that culture (Howe et al., 2019). Being an effective participant-observer requires “capturing ordinary activities and their social meanings” (Verdon, 2014, p. 110). Taking an ethnographic approach is not reserved for research, but rather a highly effective clinical tool for SLPs (De Lamo, White & Jin, 2011). An ethnographic approach to assessment might involve keeping notes about how parents and children “felt and what their intentions and motivations were” during interviews or observations, rather than just recording what they have said (Verdon, 2014, p. 110). Spending time with a family in context can help form a more comprehensive picture of how the child is functioning within the family and with others. • Desire for more intervention/professional support • Limited specialised knowledge of cleft palate in rural areas • Long distances to travel for specialist services • Barriers to accessing childcare • One family member may be unable to work due to additional care requirements Sophia is a 3-year-old girl with a repaired cleft palate and a global developmental delay associated with a rare genetic condition who participated in the Toddlers with Cleft Palate Study. She loves music and Elmo from Sesame St. Sophia’s family made the choice to move to a rural town a long way from their family and friends, where they could afford to to live on one income, so that one parent could leave the workforce and look after her. Sophia was not able to attend childcare as she needed support to participate and could not access additional funding to access this support. Access to allied health therapies was inconsistent, as clinicians were often sole clinicians and there was high staff turnover. Her family travelled many hours each way to reach the specialist children’s hospital for Sophia’s care where she saw multiple specialists. Sophia is loved and well-supported by her family, but her condition and additional needs have had a significant impact on her family. Sophia’s story highlights some key issues: • Strong support from family

Figure 1. An example of a young child providing assent by requesting to use the researcher’s tripod to “video” her toys (reproduced with permission from Anna Cronin, Sarah Verdon and Sharynne McLeod, 2020) Oromotor assessment An oromotor assessment is also important to note the structures involved in speech to observe occlusion, dentition, palatal integrity and movement. However, this may not always be possible with very young, or shy children. To take account of children’s rights, try to give them a way to be involved in the assessment, and provide them with choices (e.g., shall we look in mummy’s/dolly’s mouth first? Or, would you like a turn with the torch?). From a child rights perspective this involved respecting their refusal and looking for other ways to gather information, either via parent report, referral information, or observation. Speech and language assessment and analysis Children’s speech and language can be assessed by collecting a conversational sample during child-directed play, and supplemented by formal assessments. Valuable information is provided regarding strengths, needs and concerns (Table 2) (e.g., MacArthur Bates Communicative

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JCPSLP Volume 22, Number 2 2020

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