JCPSLP VOL 15 No 1 March 2013

Computer-assisted assessment and intervention

Reliability of the Focus on the Outcomes of Communication Under Six (FOCUS © ) Karla N. Washington, Bruce Oddson, Bernadette Robertson, Peter Rosenbaum and Nancy Thomas-Stonell

The purpose of this study was to determine the test-retest and inter-rater reliability of the Focus on the Outcomes of Communication Under Six (FOCUS © ). The FOCUS © is a clinical outcome measure, based on the International Classification of Functioning Disability and participation in children receiving speech- language intervention. Of the 70 children (aged 6 and younger) with speech and/or language impairments and their 13 speech- language pathologists (SLPs) who participated in the study, 22 children and 7 SLPs took part in the test-retest reliability procedures and 48 children and 6 SLPs took part in the inter-rater reliability procedures. The results revealed high correlations for both test-retest and inter-rater reliability, demonstrating the reliability of the FOCUS © across time and observers, and supporting its use by SLPs for clinical and research purposes. S peech and/or language impairment represents a high prevalence condition in young children, experienced by 4.56% to 19% of those aged 16 years and younger (Law, Boyle, Harris, Harkness, & Nye, 2000; McLeod & Harrison, 2009). For these children, there may be negative consequences on their ability to engage with others in social interactions (McCabe, 2005). The ability to participate with others is considered to be an important intervention outcome for children with speech and/or language difficulties who are receiving speech-language services (Threats, 2003; Washington, 2012). In Australia, speech-language pathologists (SLPs) are required to complete a thorough evaluation of an individual’s body functions and structures as well as activities and participation prior to commencing intervention (Speech Pathology Australia [SPA], 2011). When activities and participation are considered alongside body functions and structures, a more holistic approach to the evaluation of an individual’s communication skills can be achieved. This approach to practice has its foundation in the World Health – Children and Youth (ICF-CY), designed to capture communicative

Health Organization’s (WHO) International Classification of Functioning, Disability, and Health – Children and Youth (ICF-CY) (WHO, 2007), which SPA uses as a framework to guide assessment and intervention. The ICF-CY was derived from the International Classification of Functioning, Disability and Health (ICF) (WHO, 2001) and focuses on the birth to 18-year population. When the ICF-CY is used as a framework for assessing children’s speech and language skills, children’s body functions and structures (e.g., articulation functions, expression/reception of language), activities and participation (e.g., conversations with others) and contextual factors (e.g., languages spoken) are evaluated. Consequently, this framework promotes the consideration of outcomes at multiple levels, including at the level of communicative participation , defined as communication in life situations where knowledge, information, ideas, or feelings are exchanged (Eadie et al., 2006; Yorkston et al., 2008). For children, communicative participation involves using speech and/or language skills to send and receive messages to facilitate their inclusion with others (Washington, Thomas-Stonell, McLeod, & Warr-Leeper, 2012). Many measures are available to assess changes in the body functions and structures related to speech and language for children. Across clinical services, however, there is a growing need for the development of measures designed to capture clients’ communicative participation (Wade & De Jong, 2000; McLeod & Threats, 2008; Washington, 2007; 2010; Westby, 2007). These measures could increase our understanding of the breadth of the impact of communication impairments and speech-language intervention on children’s activities and participation. Consequently, decisions to include intervention goals that focus on communicative participation, as well as impairment, can be supported and evidence-based service provision can be facilitated. Measuring communicative participation outcomes There are a limited number of tools available for assessing communicative participation outcomes. Tools such as the American Speech-Language and Hearing Association (ASHA) Pre-K National Outcome Measure (Pre-K NOMS; ASHA, 2000), the Therapy Outcome Measures (TOMs; Enderby & John, 1997), and the Australian adaptation of the TOMS, the AusTOMs (Perry et al., 2004) are available, but are not aligned with the ICF-CY framework and so do

Keywords activities and participation outcome

measures preschool children reliability speech pathology

This article has been peer- reviewed

Karla N. Washington (top), Bruce Oddson

(centre) and Bernadette Robertson

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JCPSLP Volume 15, Number 1 2013

www.speechpathologyaustralia.org.au