Speak Out December 2019 V2 DIGITAL EDITION

Association news

Research grant report:

Addressing service delivery constraints within the Australian Context: The role of parents in intervention

Eleanor Sugden received a Higher Degree by Research Grant in 2015.

Eleanor Sugden was awarded a Speech Pathology Australia Higher Degree by Research Grant in 2015 to support her PhD study: Addressing Service Delivery Constraints within the Australian Context: The Role of Parents in Intervention. Her study, which used a multiple baselines across participants single case experimental design is summarised below. Five children with moderate to severe phonology-based speech sound disorder (SSD) and five parents participated in the intervention study. The children (3 boys and 2 girls) were aged from 3 years and 3 months to 5 years and 11 months and were all treated using the multiple oppositions intervention approach. After initial assessments and baseline periods, children attended 1 x 60-minute intervention session at the university’s speech pathology clinic per week for 8 weeks with their parents; their parents also attended a single 60-minute parent training session prior to the commencement of intervention. Between the clinic- based sessions, the children and their parents completed parent- friendly multiple oppositions activities at home. An immediate and a four-week follow-up assessment were conducted, to allow for changes in the children’s speech systems to be observed. All children showed a treatment effect to treated words, with accuracy increasing from 0% to almost 100% for all participants. Analysis of generalisation to untreated words was examined using visual analysis and calculated statistically using effect sizes, with the children showing various responses to treatment (range of effect sizes: 0.59 to 60.34). Three of the five children demonstrated a large effect size for generalisation to non- treatment words, with one child demonstrating a moderate effect, and one child demonstrating no effect. However, all children showed qualitative changes to their speech system by adding new phonemes or contrasts to their speech. Three of the five children experienced significant changes to communicative participation, measured by the Intelligibility in Context Scale (ICS) and the Focus on Outcomes of Communication Under Six (FOCUS). Measures of fidelity showed that parents were able to competently deliver the intervention (with an average of between 86.7% and 94.7% for each of the

parents), and also became more confident in delivering the intervention over time. In summary, this study arose in response to a clinical problem facing speech pathologists: that of service shortages and being unable to deliver sufficient intensity of intervention to children with phonology-based SSD. This study found that parents can be engaged to overcome this intensity shortfall. Additionally, the findings offer evidence that parents can competently deliver a complex phonological intervention after receiving comprehensive training. Further, the findings provide additional tentative evidence regarding the importance of a high dose frequency for phonological outcomes, and raise important questions regarding the roles of dose, language and motor learning in phonological interventions. The results also provide insights into the effects of tailoring in interventions for phonology-based SSD, which may afford an avenue for identifying the active ingredient or combination of ingredients needed for optimal outcomes. Finally, this study adds to the evidence-base for the multiple oppositions approach by showing that it can efficiently promote phonological learning for some children with moderate and severe SSD, and lead to meaningful changes in their communicative participation. Outcomes of the study are available at: pubs.asha.org/doi/full/10.1044/2019_AJSLP-18-0248 The freely-available supplemental materials for this article contain information about how to deliver multiple oppositions intervention and how to adapt it for delivery by trained parents. Numerous presentations have also arisen from the study, and Eleanor continues to pursue her research interest in the clinical management of speech sound disorders in children in her position at the University of Strathclyde in Glasgow. She also likes tweeting about all things to do with speech sound disorders: follow her @ speechiellie.

Cori Williams Senior Advisor Evidence-Based Practice and Research

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December 2019 www.speechpathologyaustralia.org.au

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