In order to optimize collaboration between Speech and Language Therapists (SLTs) and parents of children with Developmental Language Disorders (DLD), our aim was to study what is needed for SLTs to transition from the parent-as-therapist aide model to the FCC model and optimal collaborate with parents. Chapter 2 discusses the significance of demystifying collaborative working by making explicit how collaboration works. Chapter 3 examines SLTs’ perspectives on engaging parents in parent-child interaction therapy, utilizing a secondary analysis of interview data. Chapter 4 presents a systematic review of specific strategies that therapists can employ to enhance their collaboration with parents of children with developmental disabilities. Chapter 5 explores the needs of parents in their collaborative interactions with SLTs during therapy for their children with DLD, based on semi-structured interviews. Chapter 6 reports the findings from a behavioral analysis of how SLTs currently engage with parents of children with DLD, using data from focus groups. Chapter 7 offers a general discussion on the findings of this thesis, synthesizing insights from previous chapters to propose recommendations for practice and future research.
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Background: Collaboration between Speech and Language Therapists (SLTs) and parents is considered best practice for children with developmental disorders. However, such collaborative approach is not yet implemented in therapy for children with developmental language disorders (DLD) in the Netherlands. Improving Dutch SLTs’ collaboration with parents requires insight in factors that influence the way SLTs work with parents. Aims: To explore the specific beliefs of Dutch SLTs that influence how they collaborate with parents of children with DLD. Methods and procedures: We conducted three online focus groups with 17 SLTs using a reflection tool and fictional examples of parents to prompt their thoughts, feelings and actions on specific scenarios. Data were organised using the Theoretical Domains Framework (TDF). Outcomes and results: We identified 34 specific beliefs across nine TDF domains on how SLTs collaborate with parents of children with DLD. The results indicate that SLTs hold beliefs on how to support SLTs in collaborating with parents but also conflicting specific beliefs regarding collaborative work with parents. The latter relate to SLTs’ perspectives on their professional role and identity, their approach towards parents, and their confidence and competence in working collaboratively with parents.
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BACKGROUND: Atypical speech and language development is one of the most common developmental difficulties in young children. However, which clinical signs characterize atypical speech-language development at what age is not clear.AIM: To achieve a national and valid consensus on clinical signs and red flags (i.e. most urgent clinical signs) for atypical speech-language development in children from 1 to 6 years of age.METHODS & PROCEDURES: A two-round Delphi study in the Netherlands with a national expert panel (n = 24) of speech and language therapists was conducted. The panel members responded to web-based questionnaires addressing clinical signs. Consensus was defined as ≥ 70% of the experts agreeing on an issue.OUTCOMES & RESULTS: The first round resulted in a list of 161 characteristics of atypical speech and language development. The second round led to agreement on 124 clinical signs and 34 red flags.CONCLUSIONS & IMPLICATIONS: Dutch national consensus concerns 17-23 clinical signs per age year for the description of an atypical speech-language development in young children and three to 10 characteristics per age year being red flags for atypical speech-language development. This consensus contributes to early identification and diagnosis of children with atypical speech-language development, awareness and research.
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Background: Collaboration between parents and speech and language therapists (SLTs) is seen as a key element in family-centred models. Collaboration can have positive impacts on parental and children’s outcomes. However, collaborative practice has not been well described and researched in speech and language therapy for children and may not be easy to achieve. It is important that we gain a deeper understanding of collaborative practice with parents, how it can be achieved and how it can impact on outcomes. This understanding could support practitioners in daily practice with regard to achieving collaborative practice with parents in different contexts. Aims: To set a research agenda on collaborative practice between parents and SLTs in order to generate evidence regarding what works, how, for whom, in what circumstances and to what extent. Methods & Procedures: A realist evaluation approach was used to make explicit what collaborative practice with parents entails. The steps suggested by the RAMESES II project were used to draft a preliminary programme theory about collaborative practice between parents and SLTs. This process generates explicit hypotheses which form a potential research agenda. Discussion & Conclusions: A preliminary programme theory of collaborative practice with parents was drafted using a realist approach. Potential contextual factors (C), mechanisms (M) and outcomes (O) were presented which could be configured into causal mechanisms to help explain what works for whom in what circumstances. CMO configurations were drafted, based on the relevant literature, which serve as exemplars to illustrate how this methodology could be used. In order to debate, test and expand our hypothesized programme theory for collaborative practice with parents, further testing against a broader literature is required alongside research to explore the functionality of the configurations across contexts. This paper highlights the importance of further research on collaborative practice with parents and the potential value of realist evaluation methodology
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Children with developmental language disorders (DLDs) may experience barriers to communicative participation. Communicative participation is defined as ‘participation in life situations in which knowledge, information, ideas or feelings are exchanged’. Barriers experienced in communicative participation cannot be explained by language competence alone and are thought to be influenced by contextual factors. A better understanding of these factors will contribute to tailored speech and language therapy services for children with DLD. We conducted a focus group study with 13 speech and language therapists’ (SLTs) to explore their perspectives on contextual (environmental and personal) factors in early childhood that are associated with communicative participation in children with DLD. The personal factor of child well-being, and the environmental factors of familial support and SLT service provision were developed through thematic analysis. The potential mediating role of these factors on communicative participation implies that it is important to address contextual barriers and facilitators in speech and language therapy services.
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This PhD research explores how speech and language therapists (SLTs) can enhance the communicative participation of children with developmental language disorder (DLD) through shared decision-making with parents and a strong focus on the child's personal and environmental context. The work is grounded in the International Classification of Functioning, Disability and Health – Children and Youth Version (ICF-CY) framework (WHO, 2007), and focuses on four key concepts: DLD, communicative participation, shared decision-making, and contextual factors.
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Background: Goal setting is an essential step in the clinical reasoning process of speech and language therapists (SLTs) who provide care for children, adolescents and adults with communication disorders. In the light of person-centred care, shared or collaborative goal setting between the SLT and client is advised in (inter)national guidelines. SLTs face challenges in implementing (shared) goal setting as theoretical frameworks and practical interventions are scarce and less applicable to use with a wide range of communication vulnerable populations. Aims: A first step in developing theory and practical interventions is to explore first-hand experiences of SLTs and clients about day-to-day goal-setting practice. This study was guided by the following research question:What are the perspectives and needs of SLTs and persons with communication disorders regarding (shared) goal setting in routine SLT services? Methods & Procedures: The qualitative study was carried out in the setting of routine speech–language therapy services in community practices, primary education and neurological rehabilitation in the Netherlands. Data collection followed the principles of video-reflexive ethnography, using video footage of goal-setting conversations to facilitate semi-structured, reflexive interviews.Data analysis was based on reflexive thematic analysis. A total of 12 interviews were conducted with client–SLT dyads, covering perspectives from children, parents and adults with a range of communication difficulties and their SLTs. Outcomes & Results: Data analysis resulted in four themes, of which two contain subthemes. Each theme represents a central organizing concept found in SLT and client interviews. The themes were identified as: (1) goal setting is a complex process; (2) goal talk needs to be communication accessible; (3) communicative participation goals are hard to grasp; and (4) the importance of relationships. Topics such as power imbalance, communication vulnerability, effective communication strategies, and motivation and trust are explored under these themes. Conclusions & Implications: SLTs are encouraged to view shared goal setting as a process that needs to be explicitly planned and communicated with clients regardless of their age or communication vulnerability. SLTs have expert knowledge and skills when it comes to supporting communication and applying these skills during goal talks might strengthen shared goal setting and foster a therapeutic relationship. There is a need to concretely conceptualize and embed shared goal setting in policy and clinical guidelines. The themes reported have tentative clinical implications for developing such policy, and shared goal-setting interventions for SLT practice, under the condition that SLTs and people with communication disorders are continuously involved.
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Background Children with speech sound disorders (SSD) are at higher risk of communication breakdown, but the impact of having an SSD may vary from child to child. Determining the severity of SSD helps speech-language therapists (SLTs) to recognise the extent of the problem and to identify and prioritise children who require intervention. Aims This study aimed to identify severity factors for SSD in order to develop a multifactorial Speech Sound Disorder Severity Construct (SSDSC) using SLTs’ views and the International Classification of Functioning, Disability and Health (ICF). Method In an explorative five-staged qualitative study, the research question was answered: ‘How do SLTs determine the severity of SSD in children?’. A total of 91 SLTs from The Netherlands participated in data collection and analysis. The iterative process included three different qualitative research methodologies (thematic analysis [TA], constructivist grounded theory [CGT] and content analysis [CA]) to ensure validation of the results by means of method triangulation. Results SLTs considered nine themes: intelligibility, speech accuracy, persistence, the child's perception, impact, communicative participation, concomitant factors, professional point of view, and environmental factors. The themes were summarised in three main severity factors: (I) Speech accuracy, (II) The child's perception of the impact of their speech, and (III) Intelligibility in communication. Other severity factors were concomitant factors and impact. Expertise and support were identified as facilitators or barriers that may worsen or relieve the severity of SSD. Conclusions This study highlights the need for SLTs to rethink how they think about severity as a simplistic construct reflecting only speech accuracy. It is recommended that a broader holistic approach to measuring severity is adopted.
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Purpose: Most speech-language pathologists (SLPs) working with children with developmental language disorder (DLD) do not perform language sample analysis (LSA) on a regular basis, although they do regard LSA as highly informative for goal setting and evaluating grammatical therapy. The primary aim of this study was to identify facilitators, barriers, and needs related to performing LSA by Dutch SLPs working with children with DLD. The secondary aim was to investigate whether a training would change the actual performance of LSA. Method: A focus group with 11 SLPs working in Dutch speech-language pathology practices was conducted. Barriers, facilitators, and needs were identified using thematic analysis and categorized using the theoretical domain framework. To address the barriers, a training was developed using software program CLAN. Changes in barriers and use of LSA were evaluated with a survey sent to participants before, directly after, and 3 months posttraining. Results: The barriers reported in the focus group were SLPs’ lack of knowledge and skills, time investment, negative beliefs about their capabilities, differences in beliefs about their professional role, and no reimbursement from health insurance companies. Posttraining survey results revealed that LSA was not performed more often in daily practice. Using CLAN was not the solution according to participating SLPs. Time investment remained a huge barrier. Conclusions: A training in performing LSA did not resolve the time investment barrier experienced by SLPs. User-friendly software, developed in codesign with SLPs might provide a solution. For the short-term, shorter samples, preferably from narrative tasks, should be considered.
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Background: Despite the compelling case for engaging parents in speech and language therapy, research indicates that speech and language therapists (SLTs) currently have a leading role in the goal-setting process of therapy for children with developmental language disorder (DLD). Therefore, we set out to develop a tool that aims to support the dialogue between SLTs and parents and enhance shared decision-making about children's communicative participation goals. We used co-design techniques with SLT–practitioners to include their perspectives throughout the design process. Although co-design has been used for some years in healthcare research, it is still a relatively new research methodology in the field of speech and language therapy. Aims: To provide a detailed description of the co-design process that led to the development of a physical artefact that can support SLTs to engage parents of children with DLD in collaborative goal-setting. Methods & Procedures: The Design Council's Double Diamond model was used to develop a tool in co-design, together with eight SLTs, who participated in all stages of the development process. Usability was tested in actual goal-setting conversations between four SLTs and 11 parents of a child with DLD resulting in stepwise improvements. In addition, usability of the first and final prototypes was tested with five usability criteria that were rated on a 10-point scale by 64 SLTs. Outcomes & Results: The co-design process resulted in the development of a physical prototype of the tool called ‘ENGAGE’, consisting of a metal ‘tree trunk’ on which parents can stick magnetic ‘leaves’ containing potential participation goals for their child. The ‘tree’ shape represents a child's development and opportunities for growth. This first prototype received marks between 7.0 and 8.0 out of 10 on attractiveness, user-friendliness, safety, functionality and affordability. After several iterations, there were significantly higher marks for attractiveness, user-friendliness and safety in favour for the final prototype. Marks for functionality and affordability did not change significantly. Conclusions & Implications: As researchers we usually develop pen-and-paper tools, interview protocols, apps or questionnaires to support clinical practice. Including the SLTs’ perspectives in the design process resulted in a tree-shaped physical artefact that, according to the SLTs, helps to order information and encourages and guides their dialogue with parents. We strongly advocate the inclusion of end-users in developing innovative user-centred tools for speech and language therapy and we hope that this will become widespread practice.
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