United States

Literature Review: 

The origins of DA stem from the seminal work in the discipline of cognitive psychology. Feuerstein’s thesis was that learning potential could be identified and measured by using an interactive and dynamic assessment methodology engaging a student in a learning activity, while also recording a student’s need for modifiability (Feuerstein, et al.,, 1953; Guthke &amp; Wingenfeld, 1992, Hayword &amp; Lidz, 2007). The contemporary use of DA utilizes two primary theoretical frameworks: The zone of proximal development (Vygotsky et al., 1978) and the mediated learning experience (Feuerstein et al., 1979). DA continues to be researched and used within cognitive and educational psychology, and over the last 25 years it has been adopted and implemented within the discipline of communication disorders (Bamford, et al., 2022; Lidz &amp; Pena, 1996). 

Multiple reviews on DA in the field of CSD (Bamford et al., 2022; Hunt et al., 2022; Orellana et al., 2019) have provided evidence for the effectiveness of incorporating DA into evaluations. Studies have concluded that DA provides a context where a language disorder may be detected in students from CLD backgrounds. The highest sensitivity and specificity values have resulted when posttest scores are combined with modifiability ratings (e.g., Petersen et al., 2020). The reviews have also yielded insight into the various forms that DA can take in terms of language skills being assessed, how learning is measured, and intensity of teaching sessions.

Summary of Proposal: 

Speech-language pathologists (SLPs) play an integral role in conducting evaluations with bilingual students (ASHA, 2010). To assess language abilities in bilingual speakers, students should be assessed in all of the languages they speak (e.g., ASHA, 2010). Failure to do so can be an under- and overidentification of students from culturally and linguistically diverse backgrounds identified as having a communication disorder (Artiles &amp; Ortiz, 2002; Pena, 2000; Pena, et al., 2001). Authentic assessments, such as language sampling and dynamic assessment (DA), align with best practices for bilingual assessments (e.g., Orellana et al., 2019). Language sampling is increasingly used with students from culturally and linguistically diverse (CLD) backgrounds; however, DA is less frequently used (e.g., Garman 2015). DA methods incorporating a test-teach-retest methodology provides quantitative and qualitative evidence about a student’s ability to learn, retain, and transfer of language-based information (Orellana et al., 2019; Lidz, 1991). 

Determining the presence of a language disorder is a complex process. DA provides crucial information about the learning process that can be considered along with other converging evidence in the clinical decision-making process. Unfortunately, DA continues to be underused by SLPs in bilingual pre-referral processes and evaluations. For DA to be integrated into SLPs’ comprehensive evaluations, an exploration of barriers to implementation is warranted. Several barriers to implementing DA in practice were identified through the review of the DA literature and the authors’ experiences working with districts and SLPs. The first barrier is SLPs’ lack of confidence using DA (Gorman, 2015). An underlying problem is that of inadequate professional learning (PL) opportunities for SLPs. Districts are urged to rethink PL approaches and to adhere to the evidence based standards for PL (Learning Forward, 2011). The evidence is clear that passive inservices do not result in changes in practice. Rather, job-embedded learning opportunities in small-group learning communities with coaching, modeling, and feedback results in adult learners trying and sustaining new practices (e.g. Darling-Hammond et al., 2009). 

Thus, a critical recommendation for clinical practice is for district leadership to support efforts at high quality PL that follow the Learning Forward (2011) standards that allow for SLPs and other specialists to learn how to effectively and efficiently plan and implement DA and to analyze results. The authors recommend that districts invest in PL facilitators in learning communities where SLPs can explore how to plan, implement, and analyze results for speech, language/literacy &amp; social communication DA. Those new to the practice need scaffolds including checklists, protocols, and scripts; support with using modifiability scales; and opportunities to talk through their analysis of student performance. One area for future research is to analyze the success of the PL experiences using Guskey’s (2005) model. 

A second barrier to DA implementation concerns the complexity of DA itself. According to Bamford et al. (2022), the wide scope of DAs and the variability in methods used are both a strength of DA and a barrier to action. A recommendation to assist with this is providing checklists (e.g. Mitchell, 2021, 2022), protocols, and scripts specific to language and social language targets being selected and used across ages. An area for future research is to examine the clinicians’ fidelity using such protocols and scripts. 

A third barrier has to do with conditioned belief systems that have perpetuated over time. This occurs due to school professionals&#39; misunderstandings of current IDEA statutes (IDEA, 2004) for SPED evaluations. This contributes to the perception that DA does not meet the threshold of evaluation standards. In 2004, the reauthorization of IDEA codified into federal statute guidelines allowing for the use of assessment methods, such as DA. One recommendation is to provide SLPs with the knowledge and language to use to advocate for the use of DA and to advocate for omitting norm-referenced assessments when they are not valid. 

SLPs have been called to implement DA practices which have been recognized in the literature for over two decades within the CSD discipline, but as a field we have underused them as an assessment methodology. The barriers and recommendations are offered here to guide SLPs with options and actions to engage in DA practices. 


Statement of Purpose:

The purpose of this poster is twofold. The first aim is to identify barriers that preclude SLPs from adapting DA into their evaluation practices. The second aim is to present recommendations to facilitate DA practices within a professional learning community.


Outline:
The outline for the presentation is as follows: 

1. Background and rationale
2. Discuss supports for SLPs with planning, implementing, and analyzing dynamic assessment within a professional learning community 
3. Discuss the power of PLCs: new knowledge, access to EBP and interactive learning, job-embedded practice, sustained practice, network of support

Select References 

American Speech-Language-Hearing Association. (2010). Roles and responsibilities of speech-language pathologists in schools [Professional issues statement].
https://www.asha.org/SLP/schools/prof-consult/guidelines/

Bamford, C.K., Masso, S. Baker, E., &amp; Ballard, K. J. (2022). Dynamic assessment for children
with communication disorders: A systematic scoping review and framework. American Journal of Speech-Language Pathology, 31, 1878-1893. 

Bender, F. W., (2005). Evaluating and serving culturally and linguistically diverse students: A
process approach to reduce the under and over identification of ELL students being considered for SPED services (unpublished). National CEU Presentation Resource Manual, Portland, Oregon.

Darling-Hammond, L., Wei, R. C., Andree, A., Richardson, N., &amp; Orphanos, S. (2009). 
Professional learning in the learning profession: A status report on teacher development 
in the United States and abroad. Published by the National Staff Development Council 
and the School Redesign Network at Stanford University.

Dollaghan, C. A., &amp; Horner, E. A. (2011). Bilingual language assessment: A meta-analysis of 
diagnostic accuracy. Journal of Speech, Language, and Hearing Research, 54, 1077–1088.

Gorman, B. K. (2015). Dynamic assessment with bilinguals: A focus on increasing clinician’s 
confidence. Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations, 22, 112-121

Guskey, T. R. (2005). Taking a second look: Strong evidence reflecting the benefits of 
professional development is more important than ever before. Journal of Staff
Development, 26(1), 10-18.

Gutierrez-Clellen, V.F., &amp; Peña, E. (2001). Dynamic assessment of diverse children: A tutorial.
Language, Speech, and Hearing Services in Schools, 32(1), 212-224.

Hunt, E., Nang, C., Meldrum, S., &amp; Armstrong, E. (2022). Can dynamic assessment identify
language disorder in multilingual children? Clinical applications from a systematic
review. Language, Speech, and Hearing Services in Schools, 1-28.
https://doi.org/10.1044/2021_LSHSS-21-00094

Individuals with Disabilities Education Act (IDEA,2004). Federal Register, Volume 71, No. 156. Part II, Department of Education, 34, CFR parts 300 &amp; 301.

Learning Forward (2011). Standards for professional learning. Oxford, OH: Author. 
https://learningforward.org/

Lidz, C. S. (1991). Practitioner’s Guide to Dynamic Assessment. Guilford Press.

Mitchell, M. P. (2021, November 18). Designing Dynamic Assessment for Vocabulary. Poster 
session at the American Speech-Language-Hearing Association National Convention, 
Washington DC.

Mitchell, M. P. (2022, November 17). Planning Dynamic Assessment Around Relative Clauses. Oral session at the American Speech-Language-Hearing Association National
Convention, New Orleans, LA.

Orellana, C. I., Wada, R., &amp; Gillam, R. B. (2019). The use of dynamic assessment for the 
diagnosis of language disorders in bilingual children: A meta-analysis. American Journal of Speech-Language Pathology, 28, 1298-1317. https://doi.org/10.1044/2019_AJSLP-18-0202

Peña, E. (2000). Measurement of modifiability in children from culturally and linguistically
diverse backgrounds. Communication Disorders Quarterly, 21(2), 89-97.

Peña, E. D., Iglesias, A., &amp; Lidz, C. S. (2001). Reducing test bias through dynamic assessment of children’s word learning ability. American Journal of Speech-Language Pathology, 10, 138–154. https://doi.org/10.1044/1058-0360(2001/014)

Petersen, D. B., Tonn, P., Spencer, T. D., &amp; Foster, M. E. (2020). The classification accuracy of 
a dynamic assessment of inferential word learning for bilingual English/Spanish-speaking school-age children. Language, Speech, and Hearing Services in Schools, 51, 144-164. 

Vygotsky, L. S. (1986). Thought and language. MIT Press.

OSHA 2023

Professional Learning Communities in Action: Dynamic Assessment

Literature Review: 

The origins of DA stem from the seminal work in the discipline of cognitive psychology. Feuerstein’s thesis was that learning potential could be identified and measured by using an interactive and dynamic assessment methodology engaging a student in a learning activity, while also recording a student’s need for modifiability (Feuerstein, et al.,, 1953; Guthke & Wingenfeld, 1992, Hayword & Lidz, 2007). The contemporary use of DA utilizes two primary theoretical frameworks: The zone of proximal development (Vygotsky et al., 1978) and the mediated learning experience (Feuerstein et al., 1979). DA continues to be researched and used within cognitive and educational psychology, and over the last 25 years it has been adopted and implemented within the discipline of communication disorders (Bamford, et al., 2022; Lidz & Pena, 1996). 

Multiple reviews on DA in the field of CSD (Bamford et al., 2022; Hunt et al., 2022; Orellana et al., 2019) have provided evidence for the effectiveness of incorporating DA into evaluations. Studies have concluded that DA provides a context where a language disorder may be detected in students from CLD backgrounds. The highest sensitivity and specificity values have resulted when posttest scores are combined with modifiability ratings (e.g., Petersen et al., 2020). The reviews have also yielded insight into the various forms that DA can take in terms of language skills being assessed, how learning is measured, and intensity of teaching sessions.

Summary of Proposal: 

Speech-language pathologists (SLPs) play an integral role in conducting evaluations with bilingual students (ASHA, 2010). To assess language abilities in bilingual speakers, students should be assessed in all of the languages they speak (e.g., ASHA, 2010). Failure to do so can be an under- and overidentification of students from culturally and linguistically diverse backgrounds identified as having a communication disorder (Artiles & Ortiz, 2002; Pena, 2000; Pena, et al., 2001). Authentic assessments, such as language sampling and dynamic assessment (DA), align with best practices for bilingual assessments (e.g., Orellana et al., 2019). Language sampling is increasingly used with students from culturally and linguistically diverse (CLD) backgrounds; however, DA is less frequently used (e.g., Garman 2015). DA methods incorporating a test-teach-retest methodology provides quantitative and qualitative evidence about a student’s ability to learn, retain, and transfer of language-based information (Orellana et al., 2019; Lidz, 1991). 

Determining the presence of a language disorder is a complex process. DA provides crucial information about the learning process that can be considered along with other converging evidence in the clinical decision-making process. Unfortunately, DA continues to be underused by SLPs in bilingual pre-referral processes and evaluations. For DA to be integrated into SLPs’ comprehensive evaluations, an exploration of barriers to implementation is warranted. Several barriers to implementing DA in practice were identified through the review of the DA literature and the authors’ experiences working with districts and SLPs. The first barrier is SLPs’ lack of confidence using DA (Gorman, 2015). An underlying problem is that of inadequate professional learning (PL) opportunities for SLPs. Districts are urged to rethink PL approaches and to adhere to the evidence based standards for PL (Learning Forward, 2011). The evidence is clear that passive inservices do not result in changes in practice. Rather, job-embedded learning opportunities in small-group learning communities with coaching, modeling, and feedback results in adult learners trying and sustaining new practices (e.g. Darling-Hammond et al., 2009). 

Thus, a critical recommendation for clinical practice is for district leadership to support efforts at high quality PL that follow the Learning Forward (2011) standards that allow for SLPs and other specialists to learn how to effectively and efficiently plan and implement DA and to analyze results. The authors recommend that districts invest in PL facilitators in learning communities where SLPs can explore how to plan, implement, and analyze results for speech, language/literacy & social communication DA. Those new to the practice need scaffolds including checklists, protocols, and scripts; support with using modifiability scales; and opportunities to talk through their analysis of student performance. One area for future research is to analyze the success of the PL experiences using Guskey’s (2005) model. 

A second barrier to DA implementation concerns the complexity of DA itself. According to Bamford et al. (2022), the wide scope of DAs and the variability in methods used are both a strength of DA and a barrier to action. A recommendation to assist with this is providing checklists (e.g. Mitchell, 2021, 2022), protocols, and scripts specific to language and social language targets being selected and used across ages. An area for future research is to examine the clinicians’ fidelity using such protocols and scripts. 

A third barrier has to do with conditioned belief systems that have perpetuated over time. This occurs due to school professionals' misunderstandings of current IDEA statutes (IDEA, 2004) for SPED evaluations. This contributes to the perception that DA does not meet the threshold of evaluation standards. In 2004, the reauthorization of IDEA codified into federal statute guidelines allowing for the use of assessment methods, such as DA. One recommendation is to provide SLPs with the knowledge and language to use to advocate for the use of DA and to advocate for omitting norm-referenced assessments when they are not valid. 

SLPs have been called to implement DA practices which have been recognized in the literature for over two decades within the CSD discipline, but as a field we have underused them as an assessment methodology. The barriers and recommendations are offered here to guide SLPs with options and actions to engage in DA practices. 


Statement of Purpose:

The purpose of this poster is twofold. The first aim is to identify barriers that preclude SLPs from adapting DA into their evaluation practices. The second aim is to present recommendations to facilitate DA practices within a professional learning community.


Outline:
The outline for the presentation is as follows: 

1. Background and rationale
2. Discuss supports for SLPs with planning, implementing, and analyzing dynamic assessment within a professional learning community 
3. Discuss the power of PLCs: new knowledge, access to EBP and interactive learning, job-embedded practice, sustained practice, network of support

Select References 

American Speech-Language-Hearing Association. (2010). Roles and responsibilities of speech-language pathologists in schools [Professional issues statement].
https://www.asha.org/SLP/schools/prof-consult/guidelines/

Bamford, C.K., Masso, S. Baker, E., & Ballard, K. J. (2022). Dynamic assessment for children
with communication disorders: A systematic scoping review and framework. American Journal of Speech-Language Pathology, 31, 1878-1893. 

Bender, F. W., (2005). Evaluating and serving culturally and linguistically diverse students: A
process approach to reduce the under and over identification of ELL students being considered for SPED services (unpublished). National CEU Presentation Resource Manual, Portland, Oregon.

Darling-Hammond, L., Wei, R. C., Andree, A., Richardson, N., & Orphanos, S. (2009). 
Professional learning in the learning profession: A status report on teacher development 
in the United States and abroad. Published by the National Staff Development Council 
and the School Redesign Network at Stanford University.

Dollaghan, C. A., & Horner, E. A. (2011). Bilingual language assessment: A meta-analysis of 
diagnostic accuracy. Journal of Speech, Language, and Hearing Research, 54, 1077–1088.

Gorman, B. K. (2015). Dynamic assessment with bilinguals: A focus on increasing clinician’s 
confidence. Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations, 22, 112-121

Guskey, T. R. (2005). Taking a second look: Strong evidence reflecting the benefits of 
professional development is more important than ever before. Journal of Staff
Development, 26(1), 10-18.

Gutierrez-Clellen, V.F., & Peña, E. (2001). Dynamic assessment of diverse children: A tutorial.
Language, Speech, and Hearing Services in Schools, 32(1), 212-224.

Hunt, E., Nang, C., Meldrum, S., & Armstrong, E. (2022). Can dynamic assessment identify
language disorder in multilingual children? Clinical applications from a systematic
review. Language, Speech, and Hearing Services in Schools, 1-28.
https://doi.org/10.1044/2021_LSHSS-21-00094

Individuals with Disabilities Education Act (IDEA,2004). Federal Register, Volume 71, No. 156. Part II, Department of Education, 34, CFR parts 300 & 301.

Learning Forward (2011). Standards for professional learning. Oxford, OH: Author. 
https://learningforward.org/

Lidz, C. S. (1991). Practitioner’s Guide to Dynamic Assessment. Guilford Press.

Mitchell, M. P. (2021, November 18). Designing Dynamic Assessment for Vocabulary. Poster 
session at the American Speech-Language-Hearing Association National Convention, 
Washington DC.

Mitchell, M. P. (2022, November 17). Planning Dynamic Assessment Around Relative Clauses. Oral session at the American Speech-Language-Hearing Association National
Convention, New Orleans, LA.

Orellana, C. I., Wada, R., & Gillam, R. B. (2019). The use of dynamic assessment for the 
diagnosis of language disorders in bilingual children: A meta-analysis. American Journal of Speech-Language Pathology, 28, 1298-1317. https://doi.org/10.1044/2019_AJSLP-18-0202

Peña, E. (2000). Measurement of modifiability in children from culturally and linguistically
diverse backgrounds. Communication Disorders Quarterly, 21(2), 89-97.

Peña, E. D., Iglesias, A., & Lidz, C. S. (2001). Reducing test bias through dynamic assessment of children’s word learning ability. American Journal of Speech-Language Pathology, 10, 138–154. https://doi.org/10.1044/1058-0360(2001/014)

Petersen, D. B., Tonn, P., Spencer, T. D., & Foster, M. E. (2020). The classification accuracy of 
a dynamic assessment of inferential word learning for bilingual English/Spanish-speaking school-age children. Language, Speech, and Hearing Services in Schools, 51, 144-164. 

Vygotsky, L. S. (1986). Thought and language. MIT Press.

poster

The Oregon Speech-Language and Hearing Association (OSHA) is excited to present 2023 Fall Conference theme “Community in Action”. In addition to professional development content at the conference, we look forward to recognizing and celebrating the research, clinical work, and advocacy of our colleagues through our OSHA honors and awards.
![](https://assets.underline.io/markdown_image/1/image/92e74f01eb24c636be05cffbeb8a6fd5.png?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Credential=AKIAZP4XRUPAQFEPSF6P%2F20231005%2Feu-west-1%2Fs3%2Faws4_request&X-Amz-Date=20231005T092853Z&X-Amz-Expires=172800&X-Amz-SignedHeaders=host&X-Amz-Signature=46282c851bac71ec0759d4bc020befeafa87b9563672c42adee427c9a43129d5)

<br>
Join us from November 1st to 17th for a compelling virtual experience and continuing education opportunity to those involved in the Speech-Language & Hearing industry on the Underline platform!


#### [**OSHA 2023 On-Demand Offering**](https://drive.google.com/file/d/1jwrAmTttlBTCTRgErURL06kXcmGhJco9/view?usp=sharing)


#### [**The Official Website of the OSHA**](https://www.oregonspeechandhearing.org/fall-conference)


To access the site please register [**here**](https://www.oregonspeechandhearing.org/event-5462300). 

Please register for the 2023 OSHA Fall Conference to join the event.

The Oregon Speech-Language and Hearing Association (OSHA) promises to be a forum of growth, learning, and meaningful exchange, encompassing a rich tapestry of topics that are shaping our field in profound ways. The conference agenda is designed to address a wide array of critical subjects, each reflecting the evolving landscape of speech-language pathology. From early language and literacy development to the provision of gender-affirming and culturally responsive care, we are diving deep into the issues that matter most to our profession and the individuals we serve.

Background
CSD programs are utilizing simulation as a pedagogical tool to support student learning and development of clinical skills. Simulation experiences are designed to allow students to practice clinical skills in a low-stakes environment and to increase standardization and equity across student learning experiences (Dudding et al., 2019; Quail et al., 2016). Another benefit of simulation is the ability to observe student performance to ensure professional competency and observe skills prior to students’ initial clinical placements (Macbean, Theodoros, Davidson & Hill, 2013). Simulation pedagogy includes various methods, but one prominent method is utilization of standardized patients (SPs) which introduces a high level of fidelity to simulation experiences given the SPs ability to respond and react to students (Zraick, 2020). SPs are trained to simulate a patient in a repeatable, standardized manner in order to ensure similar learning opportunities for all students (Dudding and Nottingham, 2018). 

Pacific University uses a community-based clinical model where students are placed with community supervisors for all practicum experiences. As such, clinical faculty work diligently to form and maintain relationships with speech-language pathologists (SLPs) in the community to develop, not only clinical placements but, meaningful learning experiences in the graduate program for students to gain “hands-on” experience before their first practicum in the spring semester. The Clinical Methods and Observation course (CSD 521), completed in the first-semester of the graduate speech-language pathology program, is a foundational training course for development of students’ clinical skills prior to external clinical placements in the local community. Historically, graduate students in CSD 521participate in active learning related to hearing screening procedures in a class lab. Students were introduced to the rationale for providing hearing screenings, procedure protocol, and how to provide results to patients or caregivers. In lab, students have practiced using audiometers to complete the hearing screening protocol one to two times with lab partners. Following this preparation, students were sent out to schools in the local community to assist the school’s SLP with hearing screenings. Generally this method of preparation was successful, but students commented that more structured practice and feedback prior to working with clients would be beneficial. 

Given this student feedback, the course instructors determined that inclusion of a high-fidelity, high-quality simulation allowing students to practice a hearing screening procedure with a standardized patient could bridge the gap from class to clinic. The instructors reviewed the current simulation evidence in communication disorders and sciences (CSD) and designed “perfect practice” opportunities for students to learn the hearing screening technical procedure. Following this practice, students were expected to participate in a simulation utilizing a SP to learn the nuance of working with a live client, tracking responses online, and managing client questions and behaviors. 

Purpose 
The purpose of this study was to investigate the performance and perception of graduate students following a simulated learning experience focused on administering and analyzing results of an adult hearing screening. Investigators worked to answer three main questions, including (1) How did students perform on the simulation, (2) What did students think about the simulation, and (3) Is there a relationship between how the student performed on the simulation and how they rated it?

Methods
This simulation was completed by 32 SLP students in their first semester of graduate school before students conducted hearing screenings in the community. The objectives were: (1) Introduce yourself/explain the task in clear terms without clinical jargon, (2) Complete a hearing screening following the appropriate procedure per protocol, (3) Demonstrate clinical/critical thinking skills throughout the encounter, and (4) Use an audiometer accurately and efficiently.

Prior to the simulation students were provided with pre-learning materials, the clinical educators reviewed the simulation objectives, and the hearing screening procedure was modeled. Students practiced with each other during a lab and open practice day with access to the audiometers and mannequins to practice with faculty present to answer questions. 

On simulation day, the supervising educator led students through a scripted pre-brief. The students individually administered a hearing screening to an adult SP. The supervising educators used a rubric to evaluate each student's clinical and communication skills. Once the simulation was completed, students debriefed with their supervising educators. The supervising educators led debrief session using the PEARLS method which provided students a structured outline for reflections related to the simulation, their feelings related to performance, and knowledge acquired from the simulation experience (Walter & Cheng, 2015). Following the debriefing session, students completed a Qualtrics survey to evaluate their performance and the simulation itself.


Results
Preliminary review of the data collected by clinical educator rubrics revealed the following:
- 81% (26/32) of students met criteria for explaining the task
- 81% (26/32) of students met criteria for following the hearing screening protocol
- 97% (31/32) of students met criteria for demonstrating critical/clinical thinking skills
- 66% (21/32) of students met criteria for using the audiometer efficiently

Common feedback for students from clinical educators was: ensure the client is facing away from the student clinician, apply headphones on correct ears, minimize jargon, and consider ergonomics for using audiometer while collecting data. 

Immediately following the escape room, students completed a Qualtrics surveyto provide feedback across several simulation design and implementation areas, including a) structure, b) receiving guidance and feedback, and c) debriefing about their learning. Data is yet to be analyzed, but preliminary review appears to show that students are confident that they are learning the content of the simulation and this simulation covers critical content to prepare them for clinical practice. Qualitative feedback from the survey indicated that students were happy to have the opportunity to make mistakes in a low-stakes environment, so they would be more successful with their first clinical experience.

Conclusions/Implications 
The outcomes of this study suggest that students benefit from practicing hearing screenings in a simulated context to increase clinical confidence prior to their initial community placements. This work has positive implications for student teaching and training, as well as potential for carryover to clinical contexts to improve hearing screening practical skills in early-career SLPs.


References

Dudding, C. D., Brown, D. K., Estis, J. M., Szymanski, C., Zraick, R., & Mormer, E. (2019). Best Practices in Healthcare Simulations in Communication Sciences and Disorders Guide. Counsel of Academic Programs in Communication Science and Disorders. Available from: https://members.capcsd.org/news/Details/capcsd-ebook-best-practices-in-healthcare-simulations-in-communication-sciences-and-disorders-guide-8147 


Dudding, C.C. & Nottingham, E. E. (2018). A national survey of simulation use in university programs in communication sciences and disorders. American Journal of Speech Language Pathology, 27(1), 71-81. https://doi.org/10.1044/2017_AJSLP-17-0015 


MacBean, N., Theodoros, D., Davidson, B., & Hill, A. E. (2013). Simulated learning environments in speech-language pathology: an Australian response. International journal of speech-language pathology, 15(3), 345–357. https://doi.org/10.3109/17549507.2013.779024 


Quail, M., Brundage, S. B., Spitalnick, J., Allen, P. J., & Beilby, J. (2016). Student self-reported communication skills, knowledge and confidence across standardized patient, virtual and traditional clinical learning environments. BMC Medical Education, 16(1), 73. https://doi.org/10.1186/s12909-016-0577-5 


Walter, E. & Cheng, A. (2015) Promoting Excellence and Reflective Learning in Simulation
(PEARLS), Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare,
10(2), 106-115. https://www.doi.org10.1097/SIH.0000000000000072 


Zraick, Richard I. (2020) "Standardized Patients in Communication Sciences and Disorders: Past, Present and Future Directions," Teaching and Learning in Communication Sciences & Disorders, 4(3) https://doi.org/10.30707/TLCSD4.3/KHSI3441 



Using Simulation Practices to Refine Clinical Skills for Hearing Screenings

"Background
Clinical communication, terminology use, adaptation of the assessment tasks, responses to patient behavior, and appropriate preparation for assessment are key elements to effective cognitive assessment in clients with traumatic brain injury. Effective assessment of cognition for users of augmentative and alternative communication (AAC) requires special attention to multimodal communication techniques and consideration of cognitive demands of the AAC tools (Wallace, 2010). Students may not have opportunities to engage with AAC users in this way during their clinical placements. Barman et al. (2023) demonstrates that graduate students who have multiple opportunities to utilize AAC in clinical experiences feel more prepared to work with users of AAC after graduation.

Simulation has been shown to provide a safe environment in which students can practice and demonstrate these skills. Simulations can increase standardization, equity, consistency of student skill development and to provide a safe learning environment for clinical training (Dudding et al., 2019; Quail et al., 2016). Another advantage of using simulation in clinical education is the ability to simulate medically fragile or low incidence patients (e.g. NICU babies, tracheostomy care, COVID patients, ventilated patients, etc.). This ensures that students will have further development in these areas despite possible lack of exposures in clinical placements. Due to the limited opportunities for traditional clinical placements in medical SLP, simulations offer unique opportunities for clinical training among SLP graduate programs (Stead et al., 2020).

Standardized Patients (SPs) are one prominent method of simulation that provides a high level of fidelity. This form of simulation utilizes a person simulating a patient in a standardized, repeatable way (Dudding and Nottingham, 2018). Zraick (2020) described the current use of SPs in simulation education as a way to reach high fidelity and standardization across training experiences in a low stakes environment. Inclusion of SPs into a clinical skills program is perceived by faculty and students to be a valuable approach to learning a broad array of clinical skills. 

Purpose 
The purpose of this study was to investigate the performance of graduate students following a simulated evaluation of a 28 year old patient who had been admitted to the hospital with a traumatic brain injury and flaccid dysarthria secondary to falling in the shower and hitting her head. It was necessary to adapt assessment tools to accommodate the patient's AAC use. Investigators worked to answer four main questions, including:
How did students perform on administering a cognitive evaluation?
How did students support patient communication through utilization of AAC?
How do students think the simulation impacted their learning?
What did students think about the simulation design? 

Methods
The design of this simulated experience was based on the International Nursing Association for Clinical Simulation and Learning’s standards (INACSL; 2021), which promote rigorous training methods in simulation. This simulation was completed by 34 second year graduate students at the end of their 4th semester in the Master’s of Speech-Pathology program. One week prior to the simulation students were provided with all pre-learning materials. The educators also reviewed the simulation design, objectives, and modeled each assessment task (orientation and language comprehension, story memory, figure copying, line orientation, and trails) for the simulation as well as provided them an opportunity to see the patient’s AAC board. 

On simulation day, students arrived in groups of five and their supervising educator led them through a scripted, pre-brief lasting approximately 5 minutes. The students then completed the 25 minute simulation with the standardized patient following the predetermined script below. 

Simulation Outline - Student Actions
** Please say quoted words as cues for the standardized patient and your group members.
All: Group enters room
Student 1: 
Greet and introduce as SLP; Explain the assessment plan and ensure they have the proper support/tools to respond

“The place we are going to start is …”

(STUDENT 1 ADMINISTERS ORIENTATION & LANGUAGE COMPREHENSION)

“Great work, now we will try something else.”
Student 2:
“Next, I’m going to ask you to…”

(STUDENT 2 ADMINISTERS STORY MEMORY)

“You’re doing great, now let's change directions.”
Student 3:
“Now I’ll have you…”

(STUDENT 3 ADMINISTERS FIGURE COPYING)

“Thanks for your hard work, I just have a couple of more tasks for you.”
Student 4:
“Now I am going to ask you to…”

(STUDENT 4 ADMINISTERS LINE ORIENTATION)

“Alright, now we will try something else.”
Student 5:
“Finally, I am going to ask you to….”

(STUDENT 5 ADMINISTERS THEIR ASSESSMENT SUBTEST/S)

“Nice work on that task”

“Thank you so much for your time today...  I look forward to working with you soon and I hope you have an excellent rest of your day” 
ALL: Get up and exit room


The supervising educator used a rubric to evaluate each student's skills: (a) clinical communication, (b) terminology use, (c) adaptation of the assessment task (d) responses to patient, and (e) evidence of preparation. Once completed, supervising educators led the debrief session using the PEARLS method providing students a structured outline for reflections related to the simulation, their feelings related to performance, and knowledge acquired from the simulation. Following the debriefing, students completed a survey evaluating their simulation performance as well as provide feedback on the simulation itself. 


Conclusions/Implications 
Results from this simulation indicate a majority of students have emerging or have developed effective skills for assessing a person with ABI.  Students demonstrated the most proficiency in administering the trails task and the least proficiency within the story memory tasks. Students struggled most with adapting the task so that an AAC user could participate. Student feedback about the simulation was resoundingly positive and remarked how the simulation advanced their learning, helped them to reflect on assessment skills, and provided them with exposure to a patient with limited verbal communication. One student remarked, “I appreciated the low stakes environment and gained some good insights into interactions with folks who are using low-tech AAC.” Students provided positive feedback on aspects of the simulation design and implementation. This work has implications for student training and potential for carryover to clinical contexts to improve effective assessment skills in early career speech-language pathologists. 

References

Barman, B. E., Dubasik, V. L., Brackenbury, T., & Colcord, D. J. (2023). Graduate Students' Perceived Preparedness and Confidence to Work With Individuals Who Use Augmentative and Alternative Communication. American Journal of Speech-Language Pathology, 1-17.
https://doi.org/10.1044/2023_AJSLP-22-00282
Dudding, C. D., Brown, D. K., Estis, J. M., Szymanski, C., Zraick, R., & Mormer, E. (2019). Best Practices in Healthcare Simulations in Communication Sciences and Disorders Guide. Counsel of Academic Programs in Communication Science and Disorders. Available from: https://members.capcsd.org/news/Details/capcsd-ebook-best-practices-in-healthcare-simulations-in-communication-sciences-and-disorders-guide-8147 
Dudding, C.C. & Nottingham, E. E. (2018). A national survey of simulation use in university programs in communication sciences and disorders. American Journal of Speech Language Pathology, 27(1), 71-81. https://doi.org/10.1044/2017_AJSLP-17-0015 
INACSL Standards Committee, Hallmark, B., Brown, M., Peterson, D., Fey, M., Decker, S., Wells-Beede, E., Britt, T., Hardie, L., Shum, C., Arantes, H., Charnetski, M., & Morse, C.  (2021).  Healthcare Simulation Standards of Best PracticeTM Professional Development.  
Quail, M., Brundage, S. B., Spitalnick, J., Allen, P. J., & Beilby, J. (2016). Student self-reported communication skills, knowledge and confidence across standardized patient, virtual and traditional clinical learning environments. BMC Medical Education, 16(1), 73. https://doi.org/10.1186/s12909-016-0577-5    
Stead, A., Lemoncello, R., Fitzgerald, C., Fryer, M., Frost, M., & Palmer, R. (2020). Clinical simulations in academic courses: Four case studies across the medical SLP graduate curriculum. Teaching and Learning in Communication Sciences & Disorders, 4(3), 6.
Wallace, S. E. (2010). AAC use by people with TBI: Affects of cognitive impairments. Perspectives on augmentative and alternative communication, 19(3), 79-86.
Zraick, Richard I. (2020) ""Standardized Patients in Communication Sciences and DIsorders: Past, Present and Future Directions,"" Teaching and Learning in Communication Sciences & Disorders, 4(3) https://doi.org/10.30707/TLCSD4.3/KHSI3441 "

Learning Through High Fidelity Simulation: Assessing Acquired Brain Injury

Background
Speech-language pathologists (SLP) roles and responsibilities are impacted when working with clients with hearing loss. The American Speech-Language and Hearing Association (ASHA) has stated that SLPs working with individuals with hearing impairments should have specific education and training related to this population. Interprofessional education can serve to meet this need. 

Simulation has been shown to provide a safe environment in which students can practice and demonstrate skills. In addition, simulations have increased standardization, equity, and consistency of student skill development and provided a safe learning environment for student clinical training (Dudding et al., 2019; Quail et al., 2016). Interprofessional simulations are used regularly to educate students going into specific healthcare professions. However, disciplines such as audiology (AUD), SLP, and others have yet to participate regularly in interprofessional simulation work (Eichorn et al., 2021). Interprofessional simulations are beneficial, especially when partnered with similar healthcare disciplines (Alanazi & Nicholson, 2017; Bordurant, 2020; Eichorn et al., 2021). 

In addition to simulation, research has also shown that peer teaching others a subject helps retain information better and improves class performance (Rusli et al., 2021; Williams & Nguyen, 2017). Communication skills are also beneficial as students become more comfortable with the material in-depth and teach accurately (Rusli et al., 2021; Finn et al., 2023; van Vuuren, 2017). 

Purpose
This study aimed to investigate the performance and perception of graduate students following an interprofessional peer-taught simulated learning experience focused on hearing assistive technology (HAT). Investigators worked to answer three main questions, including:
Did a hearing assistive technology simulation impact SLP students' self-efficacy?
What did SLP students think about the simulation?
What was the experience of peer educators in teaching hearing assistive technology?

Methods
The standards outlined by the International Nursing Association for Clinical Simulation and Learning (INACSL, 2021) were rigorously used to design this learning experience. Thirty-five first-year SLP graduate students completed this simulation in their 3rd semester in the Master of Speech-Pathology program. Students were provided with all pre-learning materials in their clinical seminar course one week before the simulation. The clinical educators reviewed the simulation design and objectives, which included the following:
Explore a variety of hearing aids types, charging styles, and hearing assistive technologies 
Demonstrate proper insertion of both hearing protection and hearing aids
Experience what it is like to hear through a hearing aid to build patient empathy
Explore different patient scenarios and identify solutions to solve hearing-related barriers
Increase comfort with hearing aids and hearing assistive devices and troubleshoot patient hearing difficulties

All students were led through a scripted, 10-minute pre-brief on simulation day. The simulation had two components (1) The AuD peer educators presented a presentation to SLP students to lay a foundation of background information for the profession of audiology, hearing loss, and amplification, and (2) Then students broke into small groups of 6, and an AuD peer educator-led a scripted experience or simulation at each station. Each simulation station lasted approximately 30 minutes. These stations included:
Hearing assistive technology (HAT) explorations - experiential: Students explored different forms of HAT and learned how they could be utilized.
Troubleshooting and Cleaning - simulation: Students explored different patient scenarios and demonstrated problem-solving hearing-related barriers.
Insertion Practice - simulation: Students practiced inserting a hearing aid in a peer student and a custom hearing aid into an instructor while troubleshooting fit issues.
Charging options and Hearing Aid Styles - experiential: Students experienced what it was like to hear through a hearing aid to build patient empathy
Hearing Protection - simulation: Student learned and demonstrated how to insert hearing protection properly
Listening to Hearing aids - simulation: Students learned about different types of hearing aids and charging styles and demonstrated testing and changing batteries. 
Once all simulations were completed, the students moved into a structured debrief utilizing the PEARLS method. It gave students a structured outline for reflections on the simulation stations, their feelings about performance, and knowledge acquired from the simulation experience. 

Results
Student self-efficacy in using HAT was measured at three intervals surrounding the simulation. 1-week pre-simulation, immediately following, and six months post-simulation. The survey self-efficacy responses were analyzed using basic descriptive statistics and paired sample t-tests. Pre- to post-test changes in self-efficacy were statistically (p = 0.00) in all seven of the evaluated skill areas. Furthermore, Pre- to Post-post test changes remained statistically significant even with some decline in self-efficacy. Students also provided positive feedback regarding being taught by peer educators, including statements such as "It was a wonderfully comfortable learning opportunity where we could engage with peers."

For the peer audiology teachers, a survey was created for post-simulation assessment. 
Student reflection was largely positive on peer teaching students indicated high levels of agreement (average 8.9 on ten a point Likert scale) for the following statements:
By teaching, I became more confident about the topic.
I enjoy helping peers learn about my discipline.
I effectively taught my area of expertise today.
Teaching enhanced my learning.
I want to teach again to my fellow students.

Peer-teaching students indicated they struggled most with answering novel student questions.
Students also provided feedback on the simulation via a post-debrief Qualtrics survey. Results indicated that students responded positively to a) simulation structure, b) opportunities for guidance and feedback, c) working with peers, and d) debriefing about their learning. On these surveys, students consistently indicate that they are confident that:
they are mastering the content of the simulations;
the simulations cover critical content necessary for the mastery of the curriculum;
they are obtaining the required skills and knowledge from the simulations to perform tasks in clinical settings.

Conclusions/Implications 
Results from this simulation indicate that students demonstrated increased self-efficacy following an interprofessional peer-taught HAT simulation. In addition, student feedback about the simulation was resoundingly positive. Further results will be discussed within the presentation. This work has implications for student teaching and training and the potential for carryover to clinical contexts. 

References

Alanazi, A. A., & Nicholson, N. (2017). Students’ evaluation of audiology simulation training. [L’évaluation des étudiants d’une formation en audiologie utilisant des mises en situation] Canadian Journal of Speech-Language Pathology and Audiology, 41(3), 289. Retrieved from http://proxy.lib.pacificu.edu:2048/login?url=https://www.proquest.com/scholarly-journals/students-evaluation-audiology-simulation-training/docview/2003760500/se-2


Bondurant, L. M. (2020). Breaking down silos: Interprofessional collaborative practice in humanitarian audiology. Seminars in Hearing, 41(2), 092. doi:https://doi.org/10.1055/s-0040-1708506


Dudding, C. D., Brown, D. K., Estis, J. M., Szymanski, C., Zraick, R., & Mormer, E. (2019). Best Practices in Healthcare Simulations in Communication Sciences and Disorders Guide. Counsel of Academic Programs in Communication Science and Disorders. Available from: https://members.capcsd.org/news/Details/capcsd-ebook-best-practices-in-healthcare-simulations-in-communication-sciences-and-disorders-guide-8147 

Eichorn, N., Zarn, M., Moncrieff, D., Sposto, C., Lee, S., Hoffman, J. E., Levy, M., & Caplan, J. (2021). Original Interprofessional Simulations to Train Students in CSD and Related Health Professions in Team-Based Health Care. Communication Disorders Quarterly, 43(1), 23–31. https://doi.org/10.1177/1525740120942127

Finn, E., Hewetson, R., Howells, S., Clifton, J., & Cardell, E. (2023). What students can teach each other: Promoting optimal voice use for teaching through a speech-language pathology student-led voice clinic. Teaching & Teacher Education, 125, N.PAG. https://doi.org/10.1016/j.tate.2023.104053

Gottlieb, S., Martin, C., Nichols, C., & Edmondson, A. (2014). Student peer teaching in the anatomy lab enhances anatomy performance in the lowest quartile of allied health students (211.5). FASEB Journal, 28, N.PAG. https://doi.org/10.1096/fasebj.28.1_supplement.211.5

INACSL Standards Committee, Hallmark, B., Brown, M., Peterson, D., Fey, M., Decker, S., Wells-Beede, E., Britt, T., Hardie, L., Shum, C., Arantes, H., Charnetski, M., & Morse, C. (2021). Healthcare Simulation Standards of Best PracticeTM Professional Development. Clinical Simulation in Nursing, https://doi.org/10.1016/j.ecns.2021.08.007. 

Rusli, M., Degeng, N. S., Setyosari, P., & Sulton. (2021). Peer teaching: Students teaching students to increase academic performance. Teaching Theology & Religion, 24(1), 17–27. https://doi.org/10.1111/teth.12549


Quail, M., Brundage, S. B., Spitalnick, J., Allen, P. J., & Beilby, J. (2016). Student self-reported communication skills, knowledge and confidence across standardized patient, virtual and traditional clinical learning environments. BMC Medical Education, 16(1), 73. https://doi.org/10.1186/s12909-016-0577-5 


Van Vuuren, S. (2017). An integrated literature review of undergraduate peer teaching in allied health professions. African Journal of Health Professions Education, 9(1), 9–12. https://doi.org/10.7196/AJHPE.2017.v9i1.588

Williams, B., & Nguyen, D. (2017). Near-peer teaching in paramedic education: A repeated measures design. Innovations in Education & Teaching International, 54(4), 345–354. https://doi.org/10.1080/14703297.2016.1146623

Hearing Assistive Technology as Taught in a Simulated Interprofessional Environment

Background:

Augmentative and alternative communication (AAC) can mitigate the impact of communication disorders by providing an immediate mode for functional communication and visual supports to enhance comprehension while toddlers’ speech and language skills are developing (Light and McNaughton, 2012). Though AAC interventions improve children’s language, literacy, social, and adaptive skills, they are rarely initiated with toddlers during a critical period in language development (Guralnick, 2017). Timely provision of AAC intervention is vital because developing foundational functional communication and early symbolic skills are necessary to help toddlers learn vocabulary and transition to combining words (Light, et al, 2019). Caregivers of children with IDD often receive minimal instruction on AAC and supporting communication with their children at home (Baggett, et al., 2010). Without individualized, family-centered instruction, caregivers are unprepared to support AAC use and language learning at home. One promising method for expanding access to AAC intervention is teaching caregivers to use AAC and language facilitation strategies using hybrid (in-person and telehealth) models (Quinn, et al., 2021). Our goal is to understand caregivers’ preferences for an AAC intervention and the challenges of using AAC with toddlers at home. This knowledge is critical to the future success of AAC interventions because AAC interventions for toddlers lack robust social validation (Goldstein, 2016). Additionally, caregivers’ perceptions of intervention feasibility and acceptability impact intervention adoption.


Summary of Proposal:
The purpose of this study was to determine caregivers’ preferences and needs regarding two key AAC intervention components: (a) service delivery (b) strategies to enhance treatment adherence. As this research is preliminary, this poster presentation will highlight pertinent themes collected during the interview coding process. Additionally, this presentation will explore caregiver-identified barriers to successful AAC intervention implementation and discuss intervention features that may support successful outcomes in the home environment. This knowledge is critical to the future success of AAC interventions because caregivers’ perceptions of intervention feasibility and acceptability impact intervention adoption.


Purpose:
The purpose of this study was to determine caregivers’ preferences and needs regarding two key AAC intervention components: (a) service delivery and (b) strategies to enhance treatment adherence. In this project, treatment adherence strategies refer to the techniques, methods, and approaches that help family members use AAC systems and AAC intervention strategies at home. Examples may include text-message reminders, tip sheets, and caregiver instruction.


Method: 
A grounded theory approach (Corbin & Strauss, 2015) was used to collect and code caregiver interviews. Qualitative methods were applied to allow for in-depth, inductive, and dynamic exploration of factors that impact AAC use at home. Constant comparative analysis (Cresswell & Poth, 2018) was used to derive emergent themes.
Participants and setting: 
17 caregivers of children with IDD (24 – 58 months) who received early intervention services completed interviews conducted via a virtual platform. Purposive sampling strategies were used to recruit caregivers with diversity in social demographic characteristics.


Design and procedures: 
A semi-structured interview protocol was developed and revised with feedback. Questions inquired about caregivers’ global perceptions of AAC, experiences with community-based early intervention, preferences for strategies to increase treatment adherence, and preferences for service delivery. The researchers followed a three-step data processing method. First, the audio files were uploaded to Otter.Ai transcription service to prepare a verbatim transcript. Next, a researcher reviewed the entire transcription against the audio recording for accuracy and removed identifying details. Last, the cleaned transcripts were uploaded to NVivoR1.7.1 for analysis. Each interview transcript is being coded independently using an inductive and iterative process following the constant comparative method.

Results: 
Results are preliminary in nature as coding is currently in progress. Strong themes have emerged as coding has been conducted in both (a) service delivery and (b) strategies to enhance treatment adherence. Caregivers identified that in-person service delivery models promote: a) hands-on learning and caregiver self-efficacy, b) supports stronger relationships between therapist, child and caregiver (especially during the initial aspects of therapy), and c) removes the possibility of experiencing technical issues that can occur during telehealth. Caregivers identified that telehealth service delivery models promote: a) greater availability of speech-language pathologists, b) it often works better for direct parent-therapist interactions, and c) it can decrease domestic load (e.g., cleaning the house in preparation for a provider to visit, arranging schedules to be at home for the visit, etc). Caregivers identified several strategies that promoted greater adherence to treatment protocol and/or recommendations including: a) concrete and easily accessible information on AAC devices and sign language, b) videos of caregivers using AAC and sign language, c) connection with other caregivers, d) access to SLPs who have experience with AAC, and e) the ability to ask questions to between sessions. 

Discussion: 
The purpose of this study is to determine caregivers’ preferences and needs regarding two key AAC intervention components: (a) service delivery (b) strategies to enhance treatment adherence. As this research is preliminary, specific conclusions cannot be drawn to directly answer these two questions. However, some pertinent themes have been collected during the interview coding process. These themes include common caregiver-identified barriers to successful AAC intervention implementation and intervention features that may support successful outcomes in the home environment. 

References
Baggett, K. M., Davis, B., Feil, E. G., Sheeber, L. L., Landry, S. H., Carta, J. J., & Leve, C. (2010). Technologies for Expanding the Reach of Evidence-Based Interventions: Preliminary Results for Promoting Social-Emotional Development in Early Childhood. Topics in Early Childhood Special Education, 29(4), 226–238. https://doi.org/10.1177/0271121409354782


Corbin, J., & Strauss, A. (2015). Basics of qualitative research. Sage.


Chung, Y. C., & Stoner, J. B. (2016). A meta-synthesis of team members' voices: What we need and what we do to support students who use AAC. Augmentative and alternative communication, 32(3), 175–186. https://doi.org/10.1080/07434618.2016.1213766


Creswell, J.W. and Poth, C.N. (2018). Qualitative inquiry and research design choosing among five approaches. (4th ed.) Sage.


Dada, S., Flores, C., Bastable, K., & Schlosser, R. W. (2021). The effects of augmentative and alternative communication interventions on the receptive language skills of children with developmental disabilities: A scoping review. International journal of speech-language pathology, 23(3), 247–257. https://doi.org/10.1080/17549507.2020.1797165


Drager, K., Light, J., & McNaughton, D. (2010). Effects of AAC interventions on communication and language for young children with complex communication needs. Journal of pediatric rehabilitation medicine, 3(4), 303–310. https://doi.org/10.3233/PRM-2010-0141


Glaser, B. G., & Strauss, A. (1967). The discovery of grounded theory: Strategies for qualitative research. Aldine.


Goldstein H. Where does social validity measurement fit into identifying and developing evidence based practices?, Communication Interventions for Individuals with Severe Disabilites: 
Exploring Research Challenges and Opportunities. Brookes; 2016:299-312.


Guralnick M. J. (2017). Early Intervention for Children with Intellectual Disabilities: An Update. Journal of applied research in intellectual disabilities: JARID, 30(2), 211–229. https://doi.org/10.1111/jar.12233


Light, J., & McNaughton, D. (2012). The changing face of augmentative and alternative communication: past, present, and future challenges. Augmentative and alternative communication, 28(4), 197–204. https://doi.org/10.3109/07434618.2012.737024


Light, J., McNaughton, D., & Caron, J. (2019). New and emerging AAC technology supports for children with complex communication needs and their communication partners: State of the science and future research directions. Augmentative and alternative communication, 35(1), 26–41. https://doi.org/10.1080/07434618.2018.1557251


O’Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014). Standards for reporting qualitative research: A synthesis of recommendations. Academic Medicine, 89(9), 1245. https://doi.org/10.1097/ACM.0000000000000388


QSR International Pty Ltd. (2021) NVivo (released in December 2021). https://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/home



Caregiver Preferences for Early AAC Intervention: Preliminary Themes and Reflections

CSD programs are utilizing simulation as a pedagogical tool to support student learning and development of clinical skills. Simulation experiences are designed to allow students to practice clinical skills in a low-stakes environment and to increase standardization and equity across student learning experiences (Dudding et al., 2019; Quail et al., 2016). Another benefit of simulation is the ability to observe student performance to ensure professional competency and observe skills prior to students’ initial clinical placements (Macbean, Theodoros, Davidson & Hill, 2013). Simulation pedagogy includes various methods, but one prominent method is utilization of standardized patients (SPs) which introduces a high level of fidelity to simulation experiences given the SPs’ ability to respond and react to students (Zraick, 2020). SPs are trained to simulate a patient in a repeatable, standardized manner in order to ensure similar learning opportunities for all students (Dudding and Nottingham, 2018). 

A high-fidelity simulation (HFS) was implemented with first year graduate students in the speech-pathology program. The purpose of the simulation was to provide an opportunity to practice delivering patient education regarding the treatment framework for overt and covert stuttering. Students practiced using patient-friendly language, answering questions about treatment rationale, and demonstrating clinical communication skills that are appropriate for the situation and responsive to the patient. Objectives for the simulation were as follows:

At the end of the session, learners should be able to…
1. Demonstrate ability to communicate treatment framework to the patient
2. Explain rationale for both overt and covert stuttering tx
3. Respond to questions from the patient about treatment approaches
4. Demonstrate empathy for patient experiences with past treatment and concerns about the treatment framework.

The HFS experience to be presented was used as a summative assessment to replace the final examination for the course. Students participated in two parts of this activity. First, the graduate students had an opportunity to write, collaboratively, a description of steps within a treatment framework for adults who stutter, including a rationale for each step of the framework. This assignment was graded as pass/no pass, and the instructor provided constructive feedback for revisions. The second part of this experience was the interaction with the standardized patient. The purpose was to provide an opportunity to practice delivering patient education (that was prepared and revised in the first part of the assignment) regarding the treatment framework for overt stuttering and acceptance and normalization of the “below the surface” aspects of stuttering. The students were prepared to practice using patient-friendly language, answering questions about treatment rationale, and demonstrating clinical communication skills that are appropriate for the situation and responsive to the patient. All three steps of the preparation and delivery of this HFS experience will be detailed in this presentation, including the a) pre-learning and pre-briefing, b) simulation completion, and c) debriefing and guided reflection. Preliminary data (being analyzed) will be presented that represents the standardized patient’s judgment of their performance, the clinical educator’s judgment of their performance, and the students’ perception of their performance and assessment of their own learning. 

Results from this simulation indicate that the majority of students have emerging or developed effective clinical communication skills in this context. Judgements from both the lead educators and standardized patient corroborate students' skill acquisition in the areas of (a) use of terminology, (b) communication style, (c) delivery, and (e) compassionate care. Student feedback about the simulation was resoundingly positive and students remarked how the simulation advanced their learning, helped them to reflect on their clinical communication skills, and provided them with exposure to an adult who stutters. Further results will be discussed once data analysis is complete. This work has implications for student teaching and training and potential for carryover to clinical contexts to improve effective communication in early career speech-language pathologists. 

Dudding, C. D., Brown, D. K., Estis, J. M., Szymanski, C., Zraick, R., & Mormer, E. (2019). Best Practices in Healthcare Simulations in Communication Sciences and Disorders Guide. Counsel of Academic Programs in Communication Science and Disorders. Available from: https://members.capcsd.org/news/Details/capcsd-ebook-best-practices-in-healthcare-simulations-in-communication-sciences-and-disorders-guide-8147 

Dudding, C.C. & Nottingham, E. E. (2018). A national survey of simulation use in university programs in communication sciences and disorders. American Journal of Speech Language Pathology, 27(1), 71-81. https://doi.org/10.1044/2017_AJSLP-17-0015 

MacBean, N., Theodoros, D., Davidson, B., & Hill, A. E. (2013). Simulated learning environments in speech-language pathology: an Australian response. International journal of speech-language pathology, 15(3), 345–357. https://doi.org/10.3109/17549507.2013.779024 

Quail, M., Brundage, S. B., Spitalnick, J., Allen, P. J., & Beilby, J. (2016). Student self-reported communication skills, knowledge and confidence across standardized patient, virtual and traditional clinical learning environments. BMC Medical Education, 16(1), 73. https://doi.org/10.1186/s12909-016-0577-5 

Zraick, Richard I. (2020) "Standardized Patients in Communication Sciences and Disorders: Past, Present and Future Directions," Teaching and Learning in Communication Sciences & Disorders, 4(3) https://doi.org/10.30707/TLCSD4.3/KHSI3441

Stuttering Simulation: Cultivating Clinical Communication Skills in Graduate Students

Native American culture is widely misinterpreted, which has resulted in healthcare bias and inequities that has adversely affected the health and quality of life of Indigenous peoples. In this presentation, we will briefly discuss Indigenous culture, key historical outcomes, current healthcare accessibility, and explain the effects of these biases to increase cultural competence and promote culturally responsive care.

Many speech-language pathologists may be unaware of historical factors that affect care for Native American clients and cultural considerations in clinical interactions. Native American culture has rich cultural traditions. In traditional Native Americans culture, extended family is the central organizing unit, emphasizing interdependence, reciprocity, and obligation to care for one another. Within this extended network of care, children develop strong relationships and attachments with not only their immediate biological family, but also with aunts, uncles, cousins, and grandparents. (Sarche & Spicer, 2008) In some tribes, children are given tribal names, decided by an elder family member, to provide purpose and help strengthen spiritual bonds and family connection. The close intergenerational relationships also provide opportunities for elder members of the family to pass on tribal stories, songs, and practices that convey values by which to live. (Sarche & Spicer, 2008).

Historical factors caused irrevocable harm to families and communities. During the cultural invasion on Indigenous peoples, many were displaced onto reservations far from their known hunting grounds. Children were taken to boarding schools; the plan was to “Kill the Indian, Save the Man” (Gone, 2013) which meant forced enrollment of young Native American children in boarding schools initially planned to civilize and educate these young children. The hidden agenda included a stripping of native cultural identity and prohibition of cultural practices. Young Native American children were physically punished for speaking their native languages and were not allowed to practice traditional ceremonies while in these boarding schools. (Allison-Burbank, 2016) Many mass murders and massacres occurred and had the effect of substantially diminishing the NA population and tribes across the United States. (Allison-Burbank, 2016) As a result, Native American people experience generational trauma response, poverty living on rural reservations, and general mistrust of the government. 

Current Healthcare and Accessibility
When considering healthcare, Native Americans have disproportionate negative health outcomes. Native Americans experience high incidences of stroke, heart disease, diabetes, mental health concerns, obesity, alcoholism, poverty, and suicide. (www.ihs.gov) The primary health care service provider for NA persons is the Indian Health Services (IHS), a sector of the Public Health Services of the U.S. Department of Health and Human Services. Beyond constant reduction in federal funding and limited areas of service, the history of the IHS health care system has been somewhat checkered in providing preventative, primary, and specialty care to NAs across the nation. (Allison-Burbank, 2016) Although IHS fulfills treaty responsibilities to provide health care for members of more than 560 recognized tribes, Congress has consistently underfunded the agency, forcing hospital administrators to limit the services offered. As a result, tribal members have a different health care reality than many other U.S. citizens. (Americanbar.org) In 2016, the Indian Health Service budget was set at $4.8 billion. Spread across the US population of 3.7 million American Indians and Alaska Natives, that's $1,297 per person. That compares to $6,973 per inmate in the federal prison system. (Whitney, 2017) 

Historical factors, biases, and access limitations affect speech-language pathology services to Native American clients and directly impacts rapport building, establishing a trusting relationship, and developing effective goals and treatment plans that include cultural considerations. Additionally, there is little research in the field regarding Native American’s health, American Indian and Alaska Native communities have been increasingly frustrated by research that serves simply to document problems that they have long known to exist. At the same time, they are reluctant to accept interventions derived from other's experiences that do not consider their unique social and cultural contexts. (Sarche & Spicer, 2008)

Speech-language pathologists can increase culturally responsive services by researching a client’s tribal affiliation, learning about indigenous forms of learning and teaching will be helpful in tailoring services (Allison-Burbank, 2016). Future implications in research supports the recruitment and inclusion of Native Americans within study populations for preventative healthcare and treatment outcomes. We found no published studies of interventions targeting young American Indian and Alaska Native children; for older American Indian and Alaska Native children, we found only a few—most of which focused on the lack of services for American Indian and Alaska Native children or were largely descriptive and provided few data on the effectiveness of the services. (Sarche & Spicer, 2008) Acknowledge historical relevance for some clients and what generation disparities have been inherited. Identify trauma response when interacting with a client; make note when you are observing triggering behavior and help to mitigate symptoms when possible. Give additional time to build a relationship with your client that places importance on trust and open communication; unpacking years of generational trauma and trauma response will take time, and your awareness as a clinician can create positive change. If we don’t situate this problem within a societal, historical, and political context, we may inadvertently perpetuate pre-existing inequities. 


References

Sarche, M., & Spicer, P. (2008). Poverty and Health Disparities for American Indian and Alaska Native Children: Current Knowledge and Future Prospects. Annals of the New York Academy of Sciences, 1136(1), 126–136. https://doi.org/10.1196/annals.1425.017
Allison-Burbank, J. (2016) Historical Influences on Healthcare and Education in Native American Communities. Intercampus Program in Communicative Disorders, University of Kansas Kansas City, KS.
Westby, C., Moore, C., & Roman, R. (2002). Reinventing the Enemy’s Language: Developing Narratives in Native American Children. Linguistics and Education, 13(2), 235–269. https://doi.org/10.1016/S0898-5898(01)00063-8
Disparities: Fact sheets. Newsroom. (n.d.). Retrieved April 27, 2023, from https://www.ihs.gov/newsroom/factsheets/disparities/ 
Whitney, E. (2017, December 12). Native Americans feel invisible in U.S. health care system. NPR. Retrieved April 28, 2023, from https://www.npr.org/sections/health-shots/2017/12/12/569910574/native-americans-feel-invisible-in-u-s-health-care-system 
Americanbar.org. (n.d.). Retrieved April 28, 2023, from https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/native-american-crisis-in-health-equity/ 


Decolonizing Perspectives on Indigenous Healthcare

Background
Social communication is an integral part of everyday functioning and is often employed to interact with familiar and unfamiliar communicative partners to develop friendships and social connections (Macdonald, 2017). People living with acquired brain injury (ABI) often experience challenges with cognitive and communicative functions which limit their socializations or participation in everyday life activities. This affects their ability to develop and maintain friendships, community reintegration, and return to work (Mitchell et al., 2014; Salas et al., 2018).

Participating in leisure activities with peers can enhance self-identity, foster a sense of community, and yield positive health outcomes among adults with and without neurological impairments (Haslam et al., 2014). Conversely, social isolation and loneliness can negatively affect quality of life, emotional wellbeing, and increase the risk of depression and mortality among individuals with acquired brain injury (Holt-Lunstad et al., 2015; Salas et. al., 2021). Furthermore, the COVID-19 pandemic has exacerbated social isolation among individuals with ABI (Bellon et al., 2023). This has led to limited opportunities for social engagement and a lack of access to support services, consequently impacting mental health and well-being, particularly for persons who are homebound due to mobility issues or live in rural communities. Further, very few non-therapeutic opportunities exist that specifically target improvement of social communication in the context of community-based leisure reintegration (e.g., Alves-Stein et al., 2022) highlighting the critical need for such supportive opportunities for persons with ABI, specifically for those who cannot access existing in-person services. The Friends Program was established as a partnership between Brain Injury Connections-Northwest (BIC-NW) and the Department of Speech and Hearing Sciences at Portland State University to address this important gap in services for the ABI community. The program seeks to provide opportunities to reduce social isolation and enhance their social skills by developing friendships by pairing individuals who have different types of ABIs (e.g., traumatic brain injuries, strokes) with student volunteers.

Purpose
The study aims to evaluate the feasibility and acceptability of an updated iteration of the virtual Friends Program to support social connections between individuals with ABI and undergraduate student peers. 

Method
The preliminary portion of the program involved two main phases, namely recruitment and training, which were designed to ensure the successful implementation of the online version of the 5-month Friend’s Program. During the recruitment phase, speech-language pathology graduate student program leaders recruited potential student volunteers using engaging materials (e.g., informational emails, videos). Interested students completed an application to document interest in the program, their comfort and previous experience with ABI, and personal traits they would bring to the program. Matching was accomplished with the help of the leaders at Brain Injury Connection Northwest. Pairs were matched in terms of similarities of interests and specific preferences (e.g., age, gender, availability).
The next phase of the program involved training of the volunteers. Program leaders modified existing program manual and training materials and further developed them to optimize the viability of the online version of the Friends Program. Following review of training materials, all student volunteers completed the “Interact-ABI-lity” program (Togher et al., 2022) and participated in an hour-long remote training session. which covered basic information about brain injury and physical, cognitive, communication, and emotional consequences associated with it. The training also included scenario-based learning opportunities for students. Following training, all friend pairs attended an introductions meeting to exchange information and availability. Informal feedback information was sought from student volunteers regarding the program training. 

Results and Discussion
The program received 15 student volunteers, out of which seven students were selected to be matched with their friends with ABI. Preliminary analysis of the post-training survey responses from undergrad volunteers revealed an increased perception of preparedness in interacting with individuals with ABI. Students felt training was appropriate and not excessively lengthy and that they enjoyed the online formatting of the program (full results will be analyzed and presented at the OSHA conference in October 2023). 

Conclusion
Preliminary results indicate that the updated Friends Program is feasible to implement in a remote format and is well accepted by individuals with ABI and students serving as friends. Programs such as these have an immense potential to address the social communication needs, preserve self identity, and improve quality of life outcomes of those with ABI. 

References
Alves-Stein, S., George, S., Lannin, N. A., & Jolliffe, L. (2022). Implementation of a leisure reintegration programme for people with acquired brain injury in a community rehabilitation programme: A feasibility study. Brain Impairment, 1–13. 
Bellon, M., Idle, J., Lay, K., & Robinson, S. (2023). Community in the pandemic: Experiences and strategies by people with acquired brain injury and their families during COVID-19. Disability and rehabilitation, 45(6), 1038–1045. 
Haslam, C., Cruwys, T., & Haslam, S. A. (2014). “The we’s have it”: Evidence for the distinctive benefits of group engagement in enhancing cognitive health in aging. Social Science & Medicine (1982), 120, 57–66. 
Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on psychological science: a journal of the Association for Psychological Science, 10(2), 227–237. 
MacDonald, S. (2017). Introducing the model of cognitive-communication competence: A model to guide evidence-based communication interventions after brain injury. Brain Injury, 31(13-14), 1760-1780. 
Mitchell, E. J., Veitch, C., & Passey, M. (2014). Efficacy of leisure intervention groups in rehabilitation of people with an acquired brain injury. Disability and rehabilitation, 36(17), 1474–1482. 
Salas, C. E., Rojas-Líbano, D., Castro, O., Cruces, R., Evans, J., Radovic, D., Arévalo-Romero, C., Torres, J., & Aliaga, Á. (2022). Social isolation after acquired brain injury: Exploring the relationship between network size, functional support, loneliness and mental health. Neuropsychological Rehabilitation, 32(9), 2294–2318. 
Salas, C. E., Casassus, M., Rowlands, L., Pimm, S., & Flanagan, D. A. J. (2018). “Relating through sameness”: A qualitative study of friendship and social isolation in chronic traumatic brain injury. Neuropsychological Rehabilitation, 28(7), 1161–1178. 
Togher L, Brunner M, Power E, Avramovic P, Miao M, Riedijk., R (2022). Interact-ABI-lity. https://abi-communicationlab.sydney.edu.au/courses/interact-abi-lity.


Friendship in acquired brain injury: Efficacy of virtual friending program

According to the American Speech Language Hearing Association 2020 Certification Standards (ASHA, 2020), applicants for their Certification of Clinical Competence must complete a minimum of 400 clockhours of supervised clinical experience in the practice of speech-language pathology. Of the 400 clockhours required, 375 must be spent in direct client/patient contact with supervision. Clinical clockhours are obtained in graduate programs via off-campus and on-campus settings, including clinics, hospitals, schools and rely heavily on community supervisors. The issue of clinician productivity is a concern for some corporate policies, however studies have found there to be either no significant difference in productivity with a student (Bourne et al 2019) or an increase in productivity with a student (Dillon, et al 2003). Productivity aside, there are speech language pathologists that are eligible to host students but opt out. 

According to the U.S. Bureau of Labor Statistics in 2021, the field of Speech-Language Pathology was on track to have a 21% job growth rate between 2021 and 2023 whereas the national average job growth is 5%. Graduate programs must continue to enroll students at their top capacity in order to keep up with this growth however this ability may be limited due to lack of adequate supervisors willing to host students. In 2015, 33% of SLP master's programs identified insufficient clinical placements as a barrier to increasing program size (ASHA, 2015). 

This poster will systematically look at barriers and facilitators to agreeing to host graduate students based on survey data collected from 119 ASHA Certified speech language pathologists in the United States. The poster will discuss survey findings and potential changes that can be made at the University level to ensure that SLP graduate students are able to meet the minimum hour requirements for graduation while supporting the supervising SLPs in a meaningful way. 

References:
American Speech Language Hearing Association (2015). What most affects graduate program size? 20 (9). https://doi.org/10.1044/leader.AAG.20092015.28

American Speech Language Hearing Association (2020). 2020 Standards and Implementation Procedures for the Certificate of Clinical Competence in Speech-Language Pathology. Retrieved from asha.org.

Bourne, E., McAllister, L., Nagarajan, S., & Short, K. (2019). The effect of speech-language pathology students on clinician time use and activity. International Journal of Speech-Language Pathology, 21(2), 163-174. 


Bureau of Labor Statistics, U.S. Department of Labor. (2022). Speech-Language Pathologists. Occupational Outlook Handbook. Retrieved from https://www.bls.gov/ooh/healthcare/speech-language-pathologists.htm

Loretta, S. D., Tomaka, J. W., Chriss, C. E., Gutierrez, C. P., & Hairston, J. M. (2003). The Effect of Student Clinical Experiences on Clinician Productivity. Journal of Allied Health, 32(4), 261-5. https://uoregon.idm.oclc.org/login?url=https://www.proquest.com/scholarly-journals/effect-student-clinical-experiences-on-clinician/docview/210980314/se-2


Barriers and Facilitators to Externship Supervising

"In this poster presentation, we aim to 1) highlight the need for neurodiverse professionals in speech-language pathology, 2) describe barriers for neurodiverse undergraduate and graduate students, and 3) examine existing practices and/or programs at undergraduate institutions across the United States that have specific aims to recruit and support neurodiverse students. We aim to identify institutional best practices for supporting these students and consider how the initiatives may be specifically applied within undergraduate and graduate communication sciences and disorders programs. The authors of this presentation include neurodiverse undergraduate and graduate students and their allies. We note that our university, like most, does not currently have a specific program for self-identifying neurodiverse students or a neurodiverse affinity group within our Office of Equity, Diversity, and Inclusion. Knowledge gained through this project could support faculty members and administrators in higher education across institutions.     

The field of speech-language pathology benefits from having a diverse workforce. Clinicians who understand and have experienced variety within culture, dialect, and communication style are beneficial collaborators with clients, students, patients, and their families. ASHA strives to increase diversity within the workforce of speech-language pathologists (ASHA, n.d.), and it is important to recognize neurodiversity, and disability broadly, as an element within diversity, equity, and inclusion (DEI) (Donaldson, 2021). 

Professional representation of neurodiverse individuals is important. ASHA does not survey its membership related to disability or neurodiversity status; however according to a recent survey in several midwestern states, few therapists identify (via self-disclosure) as autistic: less than 3% (Freeman Barnett, 2022). Despite this, our patients, clients, and students benefit immensely from the perspectives of neurodiverse individuals, and we need to rely on input from the autistic community and autistic providers to guide our clinical services and research practices (e.g., Dorsey et al. (2020)). 

Drawing neurodiverse individuals to the field is a possible strategy; however, it is not sufficient.  The professional pathway for a career in communication sciences and disorders is rigorous and requires students to successfully complete undergraduate work, be accepted into graduate school, and succeed in graduate studies. With regard to graduate school admittance, several recent papers have described the benefits of holistic admission practices within speech-language pathology graduate programs to increase the diversity of our students (e.g., Mandulak, 2022; Guiberson & Vigil, 2021; and Wong et al., 2021). These practices value lived experiences and attempt to balance these experiences with academic metrics and other personal attributes. Application of these principles may also help support admissions for neurodiverse individuals.  

Several institutions across the United States have recently developed some dedicated systems of support (e.g., Stanford Neurodiversity Project), campus-wide education (e.g., The Neurodiversity Initiative at William & Mary), and career-specific partnerships with STEM-related organizations (e.g., NASA’s Neurodiversity Network at Sonoma State). We will conduct a comprehensive review of existing programs and describe specific actions schools have taken to meet student needs and examining career related advantages to neurodiversity (Ortiz, 2020). We aim to identify institutional best practices for supporting neurodiverse students at the undergraduate and graduate level and consider how these broadly applied practices may support those students interested in a speech-language pathology career. 

American Speech-Language-Hearing Association.(n.d.).Diversity and inclusion at ASHA. Retrieved March 29, from https://www.asha.org/About/Diversity-and-Inclusion-at-ASHA/

Donaldson, A. L. (2021). Disability in speech and hearing sciences: Reflections on representation. Perspectives of the ASHA Special Interest Groups, 6(3), 513-519.

Dorsey, R., Crow, H., & Gaddy, C. (2020). From My Perspective/Opinion: Putting Autistic Voices at the Forefront of Care. Leader Live.

Freeman Barnett, Rebecca, ""Speech-language pathologists on the autism spectrum"" (2022). Master's Theses and Doctoral Dissertations. 1127. https://commons.emich.edu/theses/1127

Guiberson, M., & Vigil, D. (2021). Speech-language pathology graduate admissions: Implications to diversify the workforce. Communication Disorders Quarterly, 42(3), 145-155.

Lizotte, M. (2018). I am a college graduate: Postsecondary experiences as described by adults with autism spectrum disorders. International Journal of Education and Practice, 6(4), 179–191. https://doi.org/10.18488/journal.61.2018.64.179.191 

Mandulak, K. C. (2022). The case for holistic review in communication sciences and disorders admissions. Perspectives of the ASHA Special Interest Groups, 7(2), 476-481.

Ortiz, L. A. (2020). Reframing neurodiversity as competitive advantage: Opportunities, challenges, and resources for business and professional communication educators. Business and Professional Communication Quarterly, 83(3), 261-284.

Wong, A. A., Marrone, N. L., Fabiano-Smith, L., Beeson, P. M., Franco, M. A., Subbian, V., & 
Lozano, G. I. (2021). Engaging faculty in shifting toward holistic review: Changing graduate admissions procedures at a land-grant, Hispanic-serving institution. American journal of speech-language pathology, 30(5), 1925-1939.

If oral presentation, we would use the following Time-Ordered Agenda: 
5 minutes—Introductions and Disclosures
15 minutes—Overview and Background
25 minutes—Case Studies for 3-4 University Programs
10 minutes—Summary and Best Practice Ideas, Consideration of barriers
I5 minutes—Conclusion and Wrap-Up

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