Abstract
http://www.flintbox.com/public/project/25193/
The FOCUS© is a new tool created at the Bloorview Kids Rehabilitation Hospital and the Bloorview Research Institute in Toronto, Canada, to measure change in preschool children receiving speech and language therapy. It consists of 50 items and takes 10 min to complete. There are two versions—one that can be completed by clinicians and one for parents. Items were derived from a content analysis of 210 parents’ observations of improvements in children’s skills following speech–language therapy (Thomas-Stonell, Oddson, Robertson, & Rosenbaum, 2009). Parents noted positive changes in speech, language, play, socialization, confidence, and behavior. The comments items are aligned with the WHO’s International Classification of Functioning–Children and Youth (World Health Organization, 2007) health framework, which provided a theoretical context for the development of the FOCUS (Thomas-Stonell, Oddson, Robertson, & Rosenbaum, 2010). The FOCUS is available in English and Spanish, and all materials can be downloaded for free from http://www.flintbox.com/public/project/25193/
The Scope of Practice for the ASHA (2007) advocates the use of the WHO-ICF for all clinical and research work in speech. Although the ICF has been part of the ASHA Scope of Practice since 2001, compared with many other countries, it is not widely used in the United States. The ICF provides a framework for describing the role of the SLP or audiologist in the prevention, assessment, and habilitation/rehabilitation, enhancement, and scientific investigation of communication and swallowing.
The ICF has two parts: Functioning and Disability and Contextual Factors. The Functioning and Disability part of the ICF includes the following:
Body structures and functions
Body Structures, defined as the anatomical parts of the body such as organs, limbs, and their components
Body Functions, defined as the physiological functions of a body system, including psychological functions
Activity, defined as the execution of a task or activity in a standard environment
Participation, defined as involvement in a life situation
The ICF-CY further distinguishes between the activity and participation by using the qualifiers of capacity and performance with capacity defined as an individual’s optimal ability to execute a task of action in a standard environment and performance defined as what an individual does in his current environment, which includes a societal context. The term communicative participation has been defined as communication in life situations where knowledge, information, ideas, or feelings are exchanged (Eadie et al., 2006).
Contextual Factors include the following:
Environmental Factors, defined as factors that are not within a person’s control, such as social support, work, government agencies, laws, attitudes of others, and cultural beliefs
Personal Factors, including specific background of the person independent of his or her health condition, as well as aspects such as race, gender, age, educational level, coping styles, upbringing, personality traits, and lifestyle (specific personal factors are not listed in the ICF)
More than 90% of the FOCUS items relate to the ICF-CY Activities and Participation domain. FOCUS items are rated on 7-point Likert-type scales. There are two scales: One varies from “Not at all like my child” to “Exactly like my child”; the second varies from “Cannot do at all” to “Can always do without help.” Each item is scored from1 to 7 resulting in a range of total scores from 50 to 350 points. Change is measured by comparing the total FOCUS score at the beginning and end of a treatment period. A higher change score indicates more change.
Following are some of the items in each of the ICF-CY domains:
Body Functions
My child speaks slowly when not understood.
My child’s speech is clear.
Activity/Capacity
My child uses correct grammar when speaking.
My child takes turns.
My child can communicate independently.
Performance
My child can communicate independently with adults who do not know my child well.
My child is understood the first time when she or he is talking with other children.
My child is understood the first time when talking with adults who do not know my child well.
My child can tell adults who do not know my child well about past events.
The FOCUS captures changes in a child’s capacity and performance as these relate to communication skills. The FOCUS has demonstrated construct validity as a change-detecting instrument. As expected, the total score measured more change during a treatment period than during a wait list period. It demonstrated construct validity with a health-related quality of life measure (Thomas-Stonell et al., 2010) and with the communication items of a measure of social/emotional skills and divergent validity with its noncommunication-related items (Thomas-Stonell, Oddson, Robertson, & Rosenbaum, 2013). Interrater and test–retest reliability has also been established (Washington, Oddson, Robertson, Rosenbaum, & Thomas-Stonell, 2013). The FOCUS has been able to measure changes in children’s communicative participation skills after 9 hr of speech–language therapy (Thomas-Stonell et al., 2010).
Measuring treatment outcomes is one way to improve services in an evidence-based manner and to inform clinical decision-making (Fujiki, Brinton, Isaacson, & Summers, 2001). Outcome measures help document the impact of intervention on children’s lives (Horowitz, Jansson, Ljungberg, & Hedenbro, 2006). Despite a move toward measuring the functional outcomes of intervention, however, few measures have been designed to capture broad communication-related outcomes such as quality of life and social participation (Dempsey & Skarakis-Doyle, 2010). This limits SLPs’ knowledge about the potential changes in these skills following speech–language intervention (Dempsey & Skarakis-Doyle, 2010; Thomas-Stonell, Oddson, & Robertson, 2009). To evaluate the full impact of intervention on a child’s life, outcome measures must capture the spectrum of changes from individual deficits to life participation (Thomas-Stonell, Oddson, Robertson, & Rosenbaum, 2009). The FOCUS provides SLPs with a way to document functional life changes in young children receiving speech and language therapy.