Attitudes toward COVID-19 vaccination among urogynecology patients

Objective

Urogynecology patients skew older and often require intimate exams to treat non-life-threatening conditions, thus making care particularly susceptible to the effects of COVID-19. We aim to understand COVID-19 vaccination attitudes amongst urogynecology patients during the pandemic, which has adversely affected healthcare delivery, to identify measures that can be undertaken to improve care going forward.

Study design

Cross-sectional surveys of urogynecology patients were conducted in three different states (Delaware, New Jersey, and Pennsylvania) between March and August 2021. Demographics, vaccination status, and COVID-19 attitudes were analyzed. Chi-square tests investigated group differences between vaccine-hesitant and unhesitant subjects.

Results

Out of 158 surveys, eighty-three percent of respondents were vaccinated or planning to get vaccinated. Older age and regular flu vaccination predicted COVID-19 vaccination. Ninety-three percent of subjects were comfortable attending in-person visits. However, vaccine-hesitant individuals were less comfortable attending in-person and were significantly less likely to be comforted by clinic interventions, such as masking. Hesitant and unhesitant groups trusted doctors or medical professionals most for their source of COVID-19 information.

Conclusions

Urogynecology patients mirror the general older population's COVID-19 vaccination attitudes, with distinct differences between hesitant and unhesitant groups. Vaccine-hesitant subjects appear less comfortable coming to in-person visits and less comforted by possible interventions, posing a difficult obstacle for clinics to overcome. High levels of patient trust suggest healthcare providers can play a crucial role in encouraging COVID-19 vaccination and combating misinformation.

Reliability and Feasibility of Administering a Child Language Assessment via Telehealth

PURPOSE

Despite the speed with which telehealth use advanced during the COVID-19 pandemic, evidence is needed to support the remote delivery of standardized assessments. This study investigated the reliability and feasibility of administering a standardized language assessment administered in real-world telehealth scenarios compared to in-person administration.

METHOD

A total of 100 children between the ages of 3 and 12 years were administered one of three versions of the Clinical Evaluation of Language Fundamentals (CELF). Children were administered the CELF by the same licensed speech-language pathologists (SLPs) in person and using telehealth, with the order counterbalanced. Means for Core Language standard scores were compared between conditions and among devices. Descriptive statistics summarized the behavior and technology disruptions during administration as well as the results of parent and SLP telehealth perception surveys.

RESULTS

In-person and telehealth mean scores on all three versions of the CELF revealed no systematic differences of one condition under- or overestimating another. The incidence of child behavior disruptions was similar for both test administration conditions. Adaptations compensated for the rare technology disruptions. Despite no significant language score and behavior differences between testing conditions, parents reported they continued to prefer in-person assessments. SLP participants viewed telehealth overall positively but identified conditions in which they continued to prefer in-person delivery.

CONCLUSIONS

This study provides evidence of minimal or no differences in scores and behavioral or technological disruptions between remote and in-person administration of the CELF core language assessments. SLP and parent participants' attitudes toward remote delivery of standardized tests appear to be evolving in a positive direction compared to previous studies.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25292752.

Efficacy of a Supplemental Small-Group Early Literacy Intervention Implemented by Early Childhood Educators

PURPOSE

Phonological awareness and alphabet knowledge are fundamental building blocks for literacy development. We identified preschoolers with persistent delays in these skills and evaluated the efficacy of a supplemental curriculum to remediate deficits in early literacy skills.

METHOD

Using a cluster design, 21 classrooms were randomly assigned to early literacy versus language intervention conditions. Sixty children identified through fall semester assessments of phonological awareness and alphabet knowledge were enrolled in small-group instruction. Teachers completed eLearning modules, used a digital platform to enter data and facilitate data-based decision making, received practice-based coaching, and delivered 12 weekly units of an early literacy curriculum. Comparison teachers delivered similarly administered small-group language instruction.

RESULTS

Large effects were evident for letter sounds, phoneme segmentation, first sound, and first sound fluency measures (d = 0.92, 4.77, 1.15, and 1.50, respectively), and nonsignificant, small effects for letter naming and blending measures (d = 0.26 and 0.27).

DISCUSSION

This early literacy intervention package had practical benefits, with 90% of experimental group preschoolers exceeding the phonemic awareness benchmark for beginning kindergarten compared to 45% in the comparison group, for example. Providing preschool teachers with tools and support for implementing a tiered approach to early literacy intervention holds promise for producing impressive gains in skills required for children to succeed in later schooling.

Speech-language pathologists' perceptions of augmentative and alternative communication in Thailand

Augmentative and alternative communication (AAC) systems are not well-known and broadly used in Thailand. To begin introducing AAC systems and interventions to children with complex communication needs in Thailand, understanding speech-language pathologists' (SLPs) perceptions toward various AAC systems is an important first step. This study assessed SLPs' perceptions of three AAC modalities: gestural communication, communication boards, and iPad1-based speech-output technologies. A total of 78 SLPs watched three video vignettes of a child using each mode and rated their impressions of intelligibility, ease of learnability and use, effectiveness, and preference. Then they were asked to rate factors on visual analog scales that provided additional insights into their rationales and their preferences for AAC modalities for nonverbal clients and for themselves if they were nonverbal. The results indicated that most of the SLPs rated iPad-based speech-output technologies as being the more intelligible, effective, and preferred mode of communication. Gestural communication was rated as the easiest mode to learn and use for a child with complex communication needs. Despite infrequent use of iPad-based speech-output technologies in Thailand, SLPs' ratings indicated high social acceptance of this modality for promoting communication abilities of children with complex communication needs. Results also revealed some biases and lack of knowledge about AAC systems in Thailand.

Using Multivariate Adaptive Regression Splines to Predict Lexical Characteristics' Influence on Word Learning in First Through Third Graders

PURPOSE

Identifying appropriate targets for vocabulary instruction and determining the optimal sequence for instruction continue to be a challenge. The purpose of this study is to investigate how previously studied lexical characteristics collectively influence children's word learning.

METHOD

A secondary data analysis was conducted using the word learning results of 350 first-, second-, and third-grade students who participated in an investigation examining the effects of a supplemental vocabulary intervention. We investigated the influence of the following lexical characteristics on the learning of 377 words: word frequency, level of concreteness, phonotactic probabilities, neighborhood density, and age of acquisition using multivariate adaptive regression splines (MARS).

RESULTS

MARS modeled the influence lexical characteristics had on word learning and determined the relative importance of each variable for each grade-level model. Results revealed age of acquisition was the most important factor related to word learning in all grades, but contributions of other lexical characteristics and their level of importance differed across models. All respective models fit well, with root-mean-square error values ranging from 0.11 to 0.15 and generalized cross validation scores of 0.01 and 0.03.

CONCLUSIONS

Nuanced information from the MARS analysis provides insights into how lexical characteristics affect word learning differently for children in different grade levels. This information is key to understanding the vocabulary acquisition of school-aged children. The findings from this research have the potential to inform the development of a word selection framework that will organize vocabulary targets into an appropriate sequence based on relevant predictors.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21899529.

Effects of Explicit Vocabulary Interventions for Preschoolers: An Exploratory Application of the Percent of Goal Obtained Effect Size Metric

PURPOSE

Systematic reviews of literature are routinely conducted to identify practices that are effective in addressing educational and clinical problems. One complication, however, is how best to combine data from both group experimental design (GED) studies and single-case experimental design (SCED) studies. Percent of Goal Obtained (PoGO) has been developed as a metric to express the size of the effect relative to the distance to a goal, which could have broad applicability. This study sought to augment this descriptive index with estimates of standard errors, which are needed to use PoGO as an effect size metric in meta-analyses of SCED and GED studies. This study investigated the application of PoGO and standard errors to both SCED and GED studies examining a common intervention approach used with a single population.

METHOD

Sixteen articles investigating explicit vocabulary instruction applied to pre-K and kindergarten students were identified. PoGO and standard errors were calculated for variations of explicit vocabulary interventions. Evaluated interventions included six studies using exclusively an SCED, nine studies using a GED, and one that used both.

RESULTS

PoGO was calculated for each treatment condition when applicable (i.e., alternating treatments designs). Standard errors and confidence interval limits also were calculated. PoGO effect size values ranged from 14.4% to 93.6%. PoGO for single-case experiments was 49.2% with a standard error of 7.26, and for group experiments, it was 30.8% with a standard error of 3.71.

CONCLUSION

Despite variation in the percentage of goal obtained across studies, the high degree of overlap in PoGO and standard errors between single-case and group experiments provides an indication that systematic reviews can apply this effect size metric to combine information obtained across experimental designs.

Psychometric Properties of a Preschool Language, Literacy, and Behavior Screener

This study investigated the psychometric properties of the Preschool Language, Literacy, and Behavior Screener (PLLB-S). We examined and tested the factor structure of the PLLB-S using exploratory and confirmatory factor analyses. We further conducted internal consistency, concurrent validity, and predictive validity analyses and evaluated teacher satisfaction using PLLB-S. Our factor analyses resulted in 22 items distributed among three subscales with high internal consistency: Oral language, emergent literacy, and behavior skills. The PLLB-S and its subscales correlated moderately to strongly with standardized measures. The emergent literacy of the PLLB-S was the only subscale that significantly predicted children’s later vocabulary knowledge. Preschool teachers reported high satisfaction with the content and purpose of the questionnaire. We concluded that this tool with sound psychometric properties can potentially help increase the feasibility and efficiency of implementing standardized assessments in MTSS frameworks in preschool classrooms.

Reliability of Scoring Telehealth Speech Sound Assessments Administered in Real-World Scenarios

PURPOSE

COVID-19 caused a worldwide conversion from in-person therapy to telehealth; however, limited evidence to support the efficacy of remotely delivering standardized tests puts the future of widespread telehealth use at risk. The aim of this study is to investigate the reliability of scoring a speech sound assessment administered in real-world scenarios including two examples of telehealth technology.

METHOD

A total of thirty-nine 3- to 8-year-olds were administered the Goldman-Fristoe Test of Articulation-Third Edition. Licensed speech-language pathologists (SLPs) concurrently scored children's responses in person and in two telehealth conditions considered typical and enhanced. Mean standard scores and interrater reliability results were compared among the three conditions. Descriptive statistics were used to summarize the frequency of technology and behavior disruptions during administration and the results of an SLP telehealth perception survey.

RESULTS

All scoring conditions were found to be highly correlated, with mean differences revealing no systematic differences of one condition over- or underestimating another. Although response agreement was high (85%-87%), final sounds in words or sounds that are difficult to observe tended to attenuate reliability. Neither child nor technology disruptions affected SLPs' ability to score responses. Despite no significant differences between conditions on scoring reliability, SLP participants reported they continued to prefer in-person over a telehealth speech sound assessment.

CONCLUSIONS

This study supports the provision of a pediatric speech sound assessment using consumer-grade equipment, as in-person, typical telehealth, and enhanced telehealth scoring conditions produced similar results. However, SLP participants' skeptical attitudes toward remote delivery of standardized tests reveal an ongoing barrier to widespread telehealth use.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19593367.

USF Pandemic Response Research Network (USF-PRRN): A Highly Integrative Basic and Responsive Research Approach to Covid-19

Pandemics represent significant threats to global health and impact all aspects of human life including physical and mental health, global economics, education, public policy and commu- nication. The diversity of impacts associated with global pandemics as well as the speed of the resulting disease spread require multidisciplinary timely approaches to address the complex interplay of factors required for pandemic mitigation. Universities provide a critical national asset for addressing pandemic mitigation as these institutions possess broad intellectual capital that can be leveraged to guide national and global responses. Universities across the United States have approached the pandemic with a variety of strategies to link disciplinary expertise to target differing aspects of the problem. The University of South Florida adapted a rapid response research network approach that essentially integrates HIBAR principles (Highly Integrative Basic and Responsive research) to address wide ranging aspects of the COVID-19 pandemic. This description of the USF Pandemic Response Research Network (USF-PRRN) highlights the HIBAR features of the network and how the USF-PRRN concept can be applied to other global sustainability challenges.

Evolution of Telehealth Technology, Evaluations, and Therapy: Effects of the COVID-19 Pandemic on Pediatric Speech-Language Pathology Services

PURPOSE

Telehealth services experienced exponential growth during the COVID-19 pandemic. This survey examined the resulting evolution in the technology, connectivity, implementation of services, and attitudes of pediatric speech-language pathology clinicians using synchronous videoconferencing.

METHOD

The Telehealth Services: Pediatric Provider Survey participants were 259 speech-language clinicians in a variety of employment settings from across the country and abroad. Analyses identified telehealth barriers eliminated and those that persisted during the pandemic, advantages, and disadvantages of remote delivery of evaluation and treatment services, the most common telehealth technology used by clinicians and their clients to access care, and clinicians' predictions about the optimization and future of telehealth.

RESULTS

Elimination of regulatory and insurance hurdles allowed children from varying socioeconomic backgrounds living in rural, suburban, and urban areas access to telehealth. Telehealth technology shifted from computers with external hardware and specialized software to commercially available equipment, such as handheld portable devices with built-in audiovisual components and publicly available videoconferencing platforms. However, connectivity of these devices continued to be problematic, and lack of technology prevented some children from accessing care. Judgments about the appropriateness and effectiveness of evaluations and treatments varied based on the age and communication disorder of a child. Although some participants expressed uncertainty about the effectiveness of telehealth compared with in-person care, telehealth was widely recognized as a viable delivery method.

CONCLUSIONS

Although clinicians reported many advantages of telehealth, some barriers identified reported prior to COVID-19 still persist. Clinicians anticipate that new developments have the potential to continue improving telehealth service delivery, bolstering the viability of telehealth long after the COVID-19 pandemic is gone.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.16959361.

Genesis of a New Generation of Telepractitioners: The COVID-19 Pandemic and Pediatric Speech-Language Pathology Services

Purpose In March 2020, the COVID-19 pandemic caused a worldwide shift from in-person care to synchronous videoconferencing or telehealth. Many barriers to remote service delivery were eliminated, effectively creating a new generation of telepractitioners. This study chronicles changes in speech-language pathology clinicians' use and perceptions of telehealth with pediatric populations. Method The Telehealth Services: Pediatric Provider Survey was created in multiple steps and then distributed broadly through social media and professional community sites. Respondents were speech-language pathologists and speech-language pathology assistants in a variety of employment settings from across the country and abroad who were serving primarily pediatric clients (n = 269). Survey questions sought to capture changes in speech-language pathology clinicians' experiences with and perceptions of telehealth before, during, and predictions after the COVID-19 pandemic. Analyses identified factors that influenced the use of telehealth services before and after March 2020 (COVID-19). Results Survey results documented the dramatic increase in telehealth use from before March 2020 to October 2020. The reasons pediatric speech-language pathology clinicians used telehealth during the pandemic were mostly a result of employer mandates or lowering infection risk for both client and clinician; however, over time, pediatric speech-language pathology clinicians increased their telehealth proficiency and discovered the benefits of telehealth. Conclusion The adoption of telehealth and the rapid improvement in proficiency is a testament to the resiliency of providers and has long-term effects on the use of telehealth into the future. Supplemental Material https://doi.org/10.23641/asha.15183690.

Speech-Language Pathologist Involvement in Multi-Tiered System of Supports Questionnaire: Advances in Interprofessional Practice

Purpose This article describes the development and initial validation of the Speech-Language Pathologist (SLP) Involvement in Multi-Tiered System of Supports (MTSS) Questionnaire. It was developed to measure the extent to which SLPs are involved in MTSS at their school site(s). Method A total of 567 SLPs practicing in the United States responded to up to 39 Likert-type items meant to reflect six domains: scope of practice, professional development, leadership, consulting/collaborating, assessment and analysis, and intervention. Measurement quality was evaluated in terms of score reliability and validity. An exploratory factor analysis was conducted to evaluate the internal structure of the questionnaire responses. A three-factor model with the following dimensions of Carrying out Roles and Responsibilities, Leading, and Planning and Providing Interventions was supported. Loadings for retained factors ranged from .35 to .87. Internal consistency estimates ranged from .87 to .92. Descriptive statistics summarized the overall involvement of SLPs in MTSS, and responses to questions to assess the feasibility and acceptability of this questionnaire were analyzed. Results Questionnaire responses indicated that SLPs infrequently engage in MTSS activities. The item with the highest mean was related to SLPs collaborating with teachers to help them address students' speech and language disorders in their classrooms. Most of the SLPs who took the questionnaire found it easy to complete, but only some found the information to be useful. Conclusions The infrequent involvement of SLPs in MTSS indicates a need to disseminate information on the potentially valuable roles SLPs can play in MTSS implementation. This tool may be used by SLPs to better understand contributions they can make within an MTSS framework and self-reflect on their current levels of involvement. Supplemental Material https://doi.org/10.23641/asha.13874516.

Feasible Implementation Strategies for Improving Vocabulary Knowledge of High-Risk Preschoolers: Results From a Cluster-Randomized Trial

Purpose Many children begin school with limited vocabularies, placing them at a high risk of academic difficulties. The goal of this study was to examine the effects of a vocabulary intervention program, Story Friends, designed to improve vocabulary knowledge of at-risk preschool children. Method Twenty-four early-childhood classrooms were enrolled in a cluster-randomized design to evaluate the effects of a revised Story Friends curriculum. In each classroom, three to four preschoolers were identified as having poor language abilities, for a total of 84 participants. In treatment classrooms, explicit vocabulary instruction was embedded in prerecorded storybooks and opportunities for review and practice of target vocabulary were integrated into classroom and home practice activities. In comparison classrooms, prerecorded storybooks included target vocabulary, but without explicit instruction, and classroom and home strategies focused on general language enrichment strategies without specifying vocabulary targets to teach. Intervention activities took place over 13 weeks, and 36 challenging, academically relevant vocabulary words were targeted. Results Children in the treatment classrooms learned significantly more words than children in the comparison classrooms, who learned few target words based on exposure. Large effect sizes (mean d = 1.83) were evident as the treatment group averaged 42% vocabulary knowledge versus 11% in the comparison group, despite a gradual decline in vocabulary learning by the treatment group over the school year. Conclusions Findings indicate that a carefully designed vocabulary intervention can produce substantial gains in children's vocabulary knowledge. The Story Friends program is feasible for delivery in early childhood classrooms and effective in teaching challenging vocabulary to high-risk preschoolers. Supplemental Material https://doi.org/10.23641/asha.13158185.

Effects of Embedding Decontextualized Language Through Book-Sharing Delivered by Mothers and Fathers in Coparenting Environments

Purpose This experiment investigated the effects of a book-sharing intervention implemented in coparenting homes on the conversations of preschoolers with their parents. Method A multiple baseline design across behaviors was used to evaluate the effects of embedding decontextualized language utterances during book-sharing delivered by four families. A visual analysis, a two-level mixed-effects model, and a social validity evaluation were used to examine the varying effects of the program on mothers and fathers' storybook conversations. Results Embedding decontextualized language prompts in books not only increased parental decontextualized language utterances, but most parents were able to maintain use of strategies without prompts in the books. The intervention effects were consistently higher for parents than for their children. Social validity results demonstrated parental satisfaction with program delivery and content. Conclusion This study adds to the limited literature on father-child and mother-child decontextualized conversations during book-sharing and illustrates a feasible and adaptable way of promoting language experiences in the home that yield engaging decontextualized conversations in meaningful book-reading contexts. Supplemental Material https://doi.org/10.23641/asha.13210799.

Trends in Clinical Practice Research in ASHA Journals: 2008-2018

Purpose Despite the American Speech-Language-Hearing Association's (ASHA's) endorsement of evidence-based practice (EBP) and speech-language pathologists' (SLPs') agreement on the importance of EBP, practicing clinicians report barriers to implementing EBP. The purpose of this study was to examine trends in clinical practice research published in ASHA journals over the past 11 years (2008-2018). Method A total of 2,483 articles from the American Journal of Speech-Language Pathology; Language, Speech, and Hearing Services in Schools; and Journal of Speech, Language, and Hearing Research were extracted for coding. Coders were licensed SLPs who were trained to 80% reliability on classifying the type of research in each article. Clinical practice research articles were further classified as studies on assessment, studies on intervention, and studies that explore the implementation of EBP. Results Clinical practice research comprised the minority of literature published in ASHA journals in the field of speech-language pathology (25%). These articles were composed of assessment (10%), intervention (15%), and implementation (< 1%). These articles were distributed across a variety of primary content areas, with an absence of implementation science for the majority of clinical areas. Conclusions The lack of clinical practice research readily available to practicing SLPs is a barrier to EBP. The results of this study underscore the need for increased clinical practice research. Future work should investigate EBP in the context of clinician-researcher partnerships and increasing the capacity of clinicians to conduct clinical practice research. Supplemental Material https://doi.org/10.23641/asha.12550928.

Effects of a Supplemental Spanish Phonological Awareness Intervention on Latinx Preschoolers' Dual Language Emergent Literacy Skills

Purpose Preschoolers' phonological awareness (PA) and alphabet knowledge (AK) skills are two of the strongest predictors of future reading. Despite evidence that providing at-risk preschoolers with timely emergent literacy interventions can prevent academic difficulties, there is a scarcity of research focusing on Latinx preschoolers who are dual language learners. Despite evidence of benefits of providing Latinxs with Spanish emergent literacy instruction, few studies include preschoolers. This study examined the effects of a supplemental Spanish PA and AK intervention on the dual emergent literacy skills of at-risk Latinx preschoolers. Method A multiple probe design across four units of instruction evaluated the effects of a Spanish supplemental emergent literacy intervention that explicitly facilitated generalizations to English. Four Latinx preschoolers with limited emergent literacy skills in Spanish and English participated in this study. Bilingual researchers delivered scripted lessons targeting PA and AK skills in individual or small groups for 12-17 weeks. Results Children made large gains as each PA skill was introduced into intervention and generalized the PA skills they learned from Spanish to English. They also improved their English initial sound identification skills, a phonemic awareness task, when instruction was delivered in Spanish but with English words. Children made small to moderate gains in their Spanish letter naming and letter-sound correspondence skills and in generalizing this knowledge to English. Conclusion These findings provide preliminary evidence Latinx preschoolers who are dual language learners benefit from emergent literacy instruction that promotes their bilingual and biliterate development.

Iterative Development of a Home Review Program to Promote Preschoolers' Vocabulary Skills: Social Validity and Learning Outcomes

Purpose This article describes the iterative development of a home review program designed to augment vocabulary instruction for young children (ages 4 and 5 years) occurring at school through the use of a home review component. Method A pilot study followed by two experiments used adapted alternating treatment designs to compare the learning of academic words taught at school to words taught at school and reviewed at home. At school, children in small groups were taught academic words embedded in prerecorded storybooks for 6 weeks. Children were given materials such as stickers with review prompts (e.g., "Tell me what brave means") to take home for half the words. Across iterations of the home intervention, the home review component was enhanced by promoting parent engagement and buy-in through in-person training, video modeling, and daily text message reminders. Visual analyses of single-subject graphs, multilevel modeling, and social validity measures were used to evaluate the additive effects and feasibility of the home review component. Results Social validity results informed each iteration of the home program. The effects of the home program across sites were mixed, with only one site showing consistently strong effects. Superior learning was evident in the school + home review condition for families that reviewed words frequently at home. Although the home review program was effective in improving the vocabulary skills of many children, some families had considerable difficulty practicing vocabulary words. Conclusion These studies highlight the importance of using social validity measures to inform iterative development of home interventions that promote feasible strategies for enhancing the home language environment. Further research is needed to identify strategies that stimulate facilitators and overcome barriers to implementation, especially in high-stress homes, to enrich the home language environments of more families.

Expanding Communication Modalities and Functions for Preschoolers With Autism Spectrum Disorder: Secondary Analysis of a Peer Partner Speech-Generating Device Intervention

Purpose This study reports a secondary analysis of the nature of communicative functions and modalities used in initiations and responses of minimally verbal preschoolers with severe autism spectrum disorder (ASD) from a previously published study (Thiemann-Bourque, Feldmiller, Hoffman, & Johner, 2018). This analysis focused on the final cohort (n = 6) from a group design study (N = 45) that examined a peer mediation and speech-generating device (SGD) intervention compared to an SGD-only condition. Method After teaching peers to use an iPad as an SGD within a modified stay-play-talk approach, school staff implemented SGD instruction in child-peer dyads during typical preschool activities. To investigate individual differences among children who demonstrated increased communication acts in the peer + SGD condition, changes in reciprocity, modalities used, and communicative functions were examined using a multiple-baseline design across children. Fidelity of implementation and social validity data were also collected. Results Six children with ASD and their peers demonstrated more balanced reciprocity, with individual differences in how and why children communicated during exchanges. That is, all children with ASD increased in SGD use as their primary communication mode; 3 children used different modalities including more speech, and 3 children used primarily gestures and SGD. The most frequent function expressed was requests for objects. More modest increases were observed in comments and requests for actions, with negligible changes in gaining attention. Social validity reports by naïve judges reflected clear improvements in communication interactions. Conclusion Findings are promising for a preschool SGD intervention that can expand children's modalities and communicative functions to engage in balanced exchanges with peer partners. Supplemental Material https://doi.org/10.23641/asha.11374203.

Classwide Extensions of Vocabulary Intervention Improve Learning of Academic Vocabulary by Preschoolers

Purpose Many preschoolers, especially those from low-income households, would benefit from instruction to enrich their vocabulary and language repertoires. Yet, explicit instruction of vocabulary and language skills generally occurs infrequently in early childhood education settings. This study investigated the additive effects of teacher-led, classwide review strategies to a previously studied small-group intervention on children's learning of academic vocabulary. Method Participants included 23 children with limited oral language skills at risk for reading difficulties enrolled in single-case experimental designs. Effects of the classroom strategies alone also were examined in 10 children with above-average language abilities from 2 classrooms. Results Visual analyses of the adapted alternating treatments designs showed consistent learning improvements when vocabulary instruction was extended into the classroom for 12 children, ceiling effects were evident for 3 participants regardless of condition, and inconsistent or minimal effects were demonstrated by 8 participants. Multilevel modeling used to evaluate the effects statistically revealed strong treatment effects. In addition, the 10 children with above-average language showed impressive learning of vocabulary words from books subject to teacher review strategies in comparison to words from books to which they were not exposed. Teachers varied in the extent to which they implemented review strategies in their classrooms. Nevertheless, their responses to social validity assessments were positive, supporting the feasibility of this intervention. Conclusions The addition of classwide review and practice opportunities is an effective means of enhancing the effects of an easy-to-implement small-group intervention that teaches challenging vocabulary words within prerecorded stories. This approach holds promise as a way to shrink the pervasive word gap that typically exists when children in high-poverty communities enter school.

Moving Forward Four Words at a Time: Effects of a Supplemental Preschool Vocabulary Intervention

Purpose This study evaluated the effects of an automated, small-group intervention designed to teach preschoolers challenging vocabulary words. Previous studies have provided evidence of efficacy. In this study, we evaluated the effects of the program after doubling the number of words taught from 2 to 4 words per book. Method Seventeen preschool children listened to 1 prerecorded book per week for 9 weeks. Each storybook had embedded, interactive lessons for 4 target vocabulary words. Each lesson provided repeated exposures to words and their definitions, child-friendly contexts, and multiple opportunities for children to respond verbally to instructional prompts. Participants were asked to define the weekly targeted vocabulary before and after intervention. A repeated acquisition single-case design was used to examine the effects of the books and embedded lessons on learning of target vocabulary words. Results Treatment effects were observed for all children across many of the books. Learning of at least 2 points (i.e., 1 word) was replicated for 74.5% of 149 books tested across the 17 participants. On average, children learned to define 47% of the target vocabulary words (17 out of 36). Conclusions Results support including 4 challenging words per book, as children learned substantially more words when 4 words were taught, in comparison to previous studies. Within an iterative development process, results of the current study take us 1 step closer to creating an optimal vocabulary intervention that supports the language development of at-risk children.

Examining Performance on a Process-Based Assessment of Word Learning in Relation to Vocabulary Knowledge and Learning in Vocabulary Intervention

Vocabulary knowledge of young children, as a well-established predictor of later reading comprehension, is an important domain for assessment and intervention. Standardized, knowledge-based measures are commonly used by speech-language pathologists (SLPs) to describe existing vocabulary knowledge and to provide comparisons to same-age peers. Process-based assessments of word learning can be helpful to provide information about how children may respond to learning opportunities and to inform treatment decisions. This article presents an exploratory study of the relation among vocabulary knowledge, word learning, and learning in vocabulary intervention in preschool children. The study examines the potential of a process-based assessment of word learning to predict response to vocabulary intervention. Participants completed a static, knowledge-based measure of vocabulary knowledge, a process-based assessment of word learning, and between 3 and 11 weeks of vocabulary intervention. Vocabulary knowledge, performance on the process-based assessment of word learning, and learning in vocabulary intervention were strongly related. SLPs might make use of the information provided by a process-based assessment of word learning to determine the appropriate intensity of intervention and to identify areas of phonological and semantic knowledge to target during intervention.

Research–Practice Partnership: Application to Implementation of Multitiered System of Supports in Early Childhood Education

Purpose

Research–practice partnerships (RPPs) offer a tool for identifying, generating, and implementing evidence-based strategies that improve practice, policies, and client outcomes. We offer a description of RPPs and elements that facilitate successful utilization. The origin of RPPs, various approaches, and anticipated barriers are discussed. We illustrate some of the challenges and rewards of establishing an RPP using an example of a project that sought to implement a multitiered system of supports among a variety of early childhood education classrooms in a large urban school district.

Method

A planning/leadership team established objectives and used surveys, focus groups, classroom observations, professional development records, and student outcome data to inform decision making.

Results

The district's progress in implementing multitiered system of supports in early childhood and ways in which implementation plans were modified as a result of data-based decision making are described. A number of unexpected obstacles interfered with original plans, requiring significant revisions in our theory of change and new strategies to overcome challenges.

Conclusion

This illustration helps elucidate critical elements of RPPs and highlights their applicability to researchers and practitioners in communication sciences and disorders.

Starting Where the Client Is

The worker's ability to truly understand a client's version of reality offers the means by which the client is enabled to take responsibility for life changes. An understanding of modern cognitive theory, and how it can be utilized, makes possible the achievement of such ability.

Surgical Outcomes of Paravaginal Repair After Robotic Sacrocolpopexy

STUDY OBJECTIVE

To evaluate surgical outcomes of robotic sacrocolpopexy with and without paravaginal repair for pelvic organ prolapse (POP).

DESIGN

A retrospective cohort study with a 3-month postoperative follow-up (Canadian Task Force classification II-3).

SETTING

An academic-affiliated community hospital with a practice comprised of 3 surgeons board certified in female pelvic medicine and reconstructive surgery.

PATIENTS

Patients undergoing robotic sacrocolpopexy for POP from April 2013 through November 2014.

INTERVENTIONS

Robotic paravaginal repair (RPVR) after robotic sacrocolpopexy. The decision to perform a paravaginal repair was at the discretion of the surgeon.

MEASUREMENTS AND MAIN RESULTS

One hundred fifty-six patients underwent a robotic sacrocolpopexy. Twenty-four patients were excluded because of a lack of a 3-month postoperative follow-up. Nine patients underwent concomitant vaginal paravaginal repair and were also excluded. Outcomes were defined by comparing preoperative characteristics with those at the 3-month follow-up. Of the 123 patients in this cohort, 21 patients underwent a concomitant RPVR, and 102 did not. All Pelvic Organ Prolapse Questionnaire (POP-Q) points improved within groups (p < .001) except for the total vaginal length (TVL) in the RPVR group (p = .940). The Patient Global Impression of Improvement (PGI-I) did not differ between groups (1.2 vs 1.5, p = .128). Subgroup analysis was performed on patients with preoperative anterior wall prolapse of stage 3 or greater. Baseline characteristics and perioperative data were not remarkably different from the main cohort. All POP-Q points improved within groups (p < .001) except for the TVL in the RPVR group (p = .572). The PGI-I did not differ between groups (1.2 vs 1.3, p = .378).

CONCLUSION

In both groups, anatomic markers substantially improved within each group. There were significant differences in postoperative POP-Q findings, which may have been influenced by the fact that patients undergoing RPVR usually had worse baseline prolapse. This selection bias creates difficulty with interpretation. Although in this study RPVR did not change subjective outcomes, further study is necessary to control for the severity of prolapse.

Predicting Response to Treatment in a Tier 2 Supplemental Vocabulary Intervention

PURPOSE

To effectively implement a response to intervention approach, there is a need for timely and specific information about student learning in response to treatment to ensure that treatment decisions are appropriate. This exploratory study examined responsivity to a supplemental, Tier 2 vocabulary intervention delivered to preschool children with limited language abilities.

METHOD

A secondary analysis of a cluster-randomized trial of a supplemental vocabulary intervention was conducted. Responsivity (e.g., adequate learning) to the intervention was examined, and learning in the 1st few weeks of intervention was evaluated as a possible predictor of response to intervention.

RESULTS

Using a criterion of learning of 20% of target vocabulary, nearly one third of participants were identified as poor responders. A 1st unit benchmark was identified that maximized the sensitivity to identification of children who were likely to respond to the intervention.

CONCLUSIONS

Even for generally effective interventions, there is likely to be a substantial proportion of children who are not responsive. Learning in the 1st few weeks of intervention may be a useful indicator of appropriate response to treatment and could inform instructional decisions.

Academic Vocabulary Learning in First Through Third Grade in Low-Income Schools: Effects of Automated Supplemental Instruction

PURPOSE

This study investigated cumulative effects of language learning, specifically whether prior vocabulary knowledge or special education status moderated the effects of academic vocabulary instruction in high-poverty schools.

METHOD

Effects of a supplemental intervention targeting academic vocabulary in first through third grades were evaluated with 241 students (6-9 years old) from low-income families, 48% of whom were retained for the 3-year study duration. Students were randomly assigned to vocabulary instruction or comparison groups.

RESULTS

Curriculum-based measures of word recognition, receptive identification, expressive labeling, and decontextualized definitions showed large effects for multiple levels of word learning. Hierarchical linear modeling revealed that students with higher initial Peabody Picture Vocabulary Test-Fourth Edition scores (Dunn & Dunn, 2007) demonstrated greater word learning, whereas students with special needs demonstrated less growth in vocabulary.

CONCLUSION

This model of vocabulary instruction can be applied efficiently in high-poverty schools through an automated, easily implemented adjunct to reading instruction in the early grades and holds promise for reducing gaps in vocabulary development.

Training Peer Partners to Use a Speech-Generating Device With Classmates With Autism Spectrum Disorder: Exploring Communication Outcomes Across Preschool Contexts

PURPOSE

This study examined effects of a peer-mediated intervention that provided training on the use of a speech-generating device for preschoolers with severe autism spectrum disorder (ASD) and peer partners.

METHOD

Effects were examined using a multiple probe design across 3 children with ASD and limited to no verbal skills. Three peers without disabilities were taught to Stay, Play, and Talk using a GoTalk 4+ (Attainment Company) and were then paired up with a classmate with ASD in classroom social activities. Measures included rates of communication acts, communication mode and function, reciprocity, and engagement with peers.

RESULTS

Following peer training, intervention effects were replicated across 3 peers, who all demonstrated an increased level and upward trend in communication acts to their classmates with ASD. Outcomes also revealed moderate intervention effects and increased levels of peer-directed communication for 3 children with ASD in classroom centers. Additional analyses revealed higher rates of communication in the added context of preferred toys and snack. The children with ASD also demonstrated improved communication reciprocity and peer engagement.

CONCLUSIONS

Results provide preliminary evidence on the benefits of combining peer-mediated and speech-generating device interventions to improve children's communication. Furthermore, it appears that preferred contexts are likely to facilitate greater communication and social engagement with peers.

Giving the community a voice: Lessons learned from a comprehensive survey in an urban neighborhood

Weinland Park, an urban neighborhood adjacent to The Ohio State University, has been targeted for revitalization following several decades of disinvestment. The goal of these efforts is to develop holistic solutions that break the cycle of poverty. Such an undertaking requires collecting baseline data to understand community needs, inform programming, and guide revitalization efforts. This paper describes the development and implementation of the Weinland Park Evaluation Project (WPEP) - a collaborative and comprehensive neighborhood survey and needs assessment. Using the RE-AIM framework as a conceptual model, the paper describes how the WPEP was designed to meet short-, medium-, and long-term community needs. In addition, it offers lessons learned as a guide for researchers designing neighborhood surveys and conducting community assessments. An Appendix A includes indicators measured via the survey tool.

Efficacy of a Supplemental Phonemic Awareness Curriculum to Instruct Preschoolers With Delays in Early Literacy Development

PURPOSE

Children who do not develop early literacy skills, especially phonological awareness (PA) and alphabet knowledge, prior to kindergarten are at risk for reading difficulties. We investigated a supplemental curriculum with children demonstrating delays in these skills.

METHOD

A cluster randomized design with 104 preschool-age children in 39 classrooms was used to determine the efficacy of a supplemental PA curriculum, PAth to Literacy. The curriculum consists of 36 daily scripted 10-min lessons with interactive games designed to teach PA and alphabet skills. A vocabulary intervention (Story Friends), which also uses a small-group format, served as the comparison condition.

RESULTS

Multilevel modeling indicated that children in the experimental condition demonstrated significantly greater gains on the Dynamic Indicators of Basic Early Literacy Skills (DIBELS) First Sound Fluency (Dynamic Measurement Group, 2006) and Word Parts Fluency (Kaminski & Powell-Smith, 2011) measures. Educational relevance was evident: 82% of the children in the experimental condition met the kindergarten benchmark for First Sound Fluency compared with 34% of the children in the comparison condition. Teachers reported overall satisfaction with the lessons.

CONCLUSIONS

Results indicated that the vast majority of children demonstrating early literacy delays in preschool may benefit from a supplemental PA curriculum that has the potential to prevent reading difficulties as children transition to kindergarten.

Embedded Instruction Improves Vocabulary Learning During Automated Storybook Reading Among High-Risk Preschoolers

PURPOSE

We investigated a small-group intervention designed to teach vocabulary and comprehension skills to preschoolers who were at risk for language and reading disabilities. These language skills are important and reliable predictors of later academic achievement.

METHOD

Preschoolers heard prerecorded stories 3 times per week over the course of a school year. A cluster randomized design was used to evaluate the effects of hearing storybooks with and without embedded vocabulary and comprehension lessons. A total of 32 classrooms were randomly assigned to experimental and comparison conditions. Approximately 6 children per classroom demonstrating low vocabulary knowledge, totaling 195 children, were enrolled.

RESULTS

Preschoolers in the comparison condition did not learn novel, challenging vocabulary words to which they were exposed in story contexts, whereas preschoolers receiving embedded lessons demonstrated significant learning gains, although vocabulary learning diminished over the course of the school year. Modest gains in comprehension skills did not differ between the two groups.

CONCLUSION

The Story Friends curriculum appears to be highly feasible for delivery in early childhood educational settings and effective at teaching challenging vocabulary to high-risk preschoolers.

Peers as clinicians: Examining the impact of Stay Play Talk on social communication in young preschoolers with autism

BACKGROUND

Peer Mediated Interventions (PMIs) can be incorporated into integrated early childhood and preschool settings to address socialization impairments observed in children with ASD (Katz & Girolametto, 2013). However, research examining specific PMI strategies with young preschoolers remains limited.

OBJECTIVE

The current study examines the efficacy of the Stay, Play, Talk PMI (English, Shafer, Goldstein, & Kaczmerek, 1997) on the social communication skills of young preschool children diagnosed with an Autism Spectrum Disorder (ASD).

METHOD

Each of 3 typically developing children (ages 3-5 years) was paired with a child with an ASD (ages 3-4 years). Typically developing peers were taught to Stay with their friend, Play with their friend, and Talk to their friend. The child dyads played together during two, 20-min weekly sessions for 6-8 weeks. A multiple baseline design across participants was implemented to measure the impact of the Stay Play Talk strategies on social initiations and responses characterized by non-coordinated gestures, gestures, and words. Simulation Modeling Analysis was also conducted to confirm visual analysis.

RESULTS

All 3 typical peer buddies and all 3 target children with ASD demonstrated increases in the frequency of their responses, reaching levels that greatly exceeded baseline levels. Further, social reciprocations increased among each dyad above baseline. Social initiations remained variable across dyads. Gains were not maintained two months post intervention.

CONCLUSION

Results of this study corroborated previous findings that support the usefulness of PMIs to improve social communication of young children with ASD (Chan et al., 2009) and suggest an economical, naturally occurring approach to improve social communication during early childhood.

LEARNING OUTCOMES

Readers will gain knowledge regarding the social communication profile of children with ASD and how this profile can negatively impact language development and peer relationships. In addition, readers will be able to identify the basic components of the Stay Play Talk intervention. Finally, this paper will explain the impacts of the Stay Play Talk intervention on the social communication skills of young children with ASD.

Developing a Phonological Awareness Curriculum: Reflections on an Implementation Science Framework

PURPOSE

This article describes the process of developing and implementing a supplemental early literacy curriculum designed for preschoolers demonstrating delays in literacy development.

METHOD

Intervention research and implementation research have traditionally been viewed as sequential processes. This article illustrates a process of intervention development that was paralleled by a focus on implementation in early childhood settings. The exploration, preparation, implementation, sustainment framework is used to describe factors that need to be considered during a progression through these 4 phases of implementation. A post hoc analysis provides insight into a rather nonlinear progression of intervention development and highlights considerations and activities that have facilitated implementation.

CONCLUSIONS

The guiding principles of the exploration, preparation, implementation, sustainment implementation science framework highlight the important considerations in developing effective and practical interventions. Considering implementation and sustainment during the intervention development process and using data-based decision making has the potential to expand the availability of user-friendly evidence-based practices in communication sciences and disorders and encourage a bridging of the researcher-clinician gap.

Small groups, big gains: efficacy of a tier 2 phonological awareness intervention with preschoolers with early literacy deficits

PURPOSE

The purpose of the present study was to evaluate the efficacy of a phonological awareness (PA) intervention, designed for Tier 2 instruction in a Response to Intervention (RTI) model, delivered to small groups of preschoolers.

METHOD

A multiple-baseline design across participants was used to evaluate the efficacy of the intervention on low-income preschool children's PA skills. A trained interventionist delivered small group sessions 3 to 4 days a week and ensured children received frequent opportunities to respond and contingent feedback. Participants received 28 to 36 lessons that lasted about 10 min each and focused on PA and alphabet knowledge. Initiation of intervention was staggered across 3 triads, and 7 children completed the study.

RESULTS

The intervention produced consistent gains on weekly progress monitoring assessments of the primary outcome measure for first sound identification (First Sound Fluency). Most children also demonstrated gains on other measures of PA and alphabet knowledge.

CONCLUSIONS

Results provide support for the application of a small group intervention consistent with an RTI framework and document the potential benefits of the intervention to learners who need early literacy instruction beyond the core curriculum.

Generation of β cell-specific human cytotoxic T cells by lentiviral transduction and their survival in immunodeficient human leucocyte antigen-transgenic mice

Several β cell antigens recognized by T cells in the non-obese diabetic (NOD) mouse model of type 1 diabetes (T1D) are also T cell targets in the human disease. While numerous antigen-specific therapies prevent diabetes in NOD mice, successful translation of rodent findings to patients has been difficult. A human leucocyte antigen (HLA)-transgenic mouse model incorporating human β cell-specific T cells might provide a better platform for evaluating antigen-specific therapies. The ability to study such T cells is limited by their low frequency in peripheral blood and the difficulty in obtaining islet-infiltrating T cells from patients. We have worked to overcome this limitation by using lentiviral transduction to 'reprogram' primary human CD8 T cells to express three T cell receptors (TCRs) specific for a peptide derived from the β cell antigen islet-specific glucose-6-phosphatase catalytic subunit-related protein (IGRP265-273 ) and recognized in the context of the human class I major histocompatibility complex (MHC) molecule HLA-A2. The TCRs bound peptide/MHC multimers with a range of avidities, but all bound with at least 10-fold lower avidity than the anti-viral TCR used for comparison. One exhibited antigenic recognition promiscuity. The β cell-specific human CD8 T cells generated by lentiviral transduction with one of the TCRs released interferon (IFN)-γ in response to antigen and exhibited cytotoxic activity against peptide-pulsed target cells. The cells engrafted in HLA-A2-transgenic NOD-scid IL2rγ(null) mice and could be detected in the blood, spleen and pancreas up to 5 weeks post-transfer, suggesting the utility of this approach for the evaluation of T cell-modulatory therapies for T1D and other T cell-mediated autoimmune diseases.