2/7/2011

Agenda
CLINICAL RESEARCH
• Overview and Introduction (15 minutes)
COLLABORATION • Panelist Presentations (60 minutes)
• Break-out Roundtable Discussions (40 minutes)
ROUNDTABLE • Closing Remarks (5 minutes)

Sponsored by the Evidence-Based Practice

Committee

Objectives
• Describe several clinical research projects in Illinois
• Discuss three methods of addressing clinical research
questions
• Identify opportunities for clinical research collaboration
Panelists
• Catherine Balthazar, Ph.D., CCC-SLP
• Associate Professor at Governors State University
• Courses: child language development, language
disorders, research, professional issues, and phonological
disorders
• Specialties: developmental language disorders, treatment
efficacy, school-age language, single subject design

Panelists
• Jennifer Armstrong, Ph.D., CCC-SLP
• Assistant Professor at Governors State University
• Courses: Introduction/Advanced Assessment and
Intervention to Communication Disorders; Early Language
Disorders
• Specialties/Interests: Language and literacy development
in early childhood populations; Prevention of speech and
language disorders; Language Development in Special
Populations
Panelists
• Nicole Koonce, M.A., CCC-SLP
• Position: Research Assistant, Building Complex
Sentences Project; Doctoral Candidate in Special
Education, University of Illinois at Chicago
• Specialties: Evidenced-based interventions for school-age
children with language and reading disabilities, Issues in
the assessment of individuals from culturally and
linguistically diverse backgrounds; Collaborative models
of service delivery in educational settings

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Panelists Clinician-Researcher Collaboration

• Gail B. Kempster, Ph.D., CCC-SLP
• Position: Associate Professor and SLP Program Director
at Rush University
• Courses: anatomy and physiology of the speech system,
research methods in CDS, voice disorders
• Specialties: voice disorders, perceptual voice analysis,
research design and statistics
• Generates clinically relevant research questions
• Guides methodology of clinical studies
• Promotes adoption of research-based methods in clinical
settings
• Connects clients to state-of-the-art treatments

A Word About Levels of

Phases of Clinical Outcomes Research
Evidence
Phase Purpose Methods

Levels of Evidence Phase I The intervention and its hypothesized Observational or correlational, estimates
effects are identified of effect size
Ia Preliminary

Phase II Clinical viability of the intervention is Case studies, discovery-oriented single-

tested subject designs, and small group cohort
Ib Feasibility control studies

IIa Phase III Begin to test efficacy Experimental, or at least quasi-

experimental; test causality
Early Efficacy
IIb
Phase IV Compare target intervention with Experimental
alternative intervention to address
III Later Efficacy causality under more generalizable
conditions
IV
Phase V Determining whether the therapeutic "field research" or "community-based
effect is realized in day-to-day clinical research"
Effectiveness practice

Mixed Method: Adding qualitative and

quantitative approaches
• Qualitative component is meant to:
• Gain insights into subjective issues
• Investigate a topic from a deep rather than a broad perspective
• Identify issues and opinions specific to small groups of people

FEATURED RESEARCH • Qualitative component does not (but quantitative can):

• Lend itself to generalization

METHODS • Indicate a single best answer to a research question

• Generate objective numerical data which can be analyzed
statistically
• Sources of information
• Interviews (structured, semi-structured)
• Focus groups
• Open-ended written surveys

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Single-Subject: Measuring effects on Validation: Relating measures to

individuals constructs
• Can help answer important clinical questions • Concerned with developing measures that are
• Does this treatment work? • RELIABLE
• ABAB Withdrawal
• Multiple Baseline Across Behaviors • Produce comparable results consistently
• Changing Criterion
• Produce similar results among examiners
• Which treatment is better?
• Alternating Treatments Design • VALID
• Which parts are effective?
• Interaction Design • Scores reflect differences in target trait
• Particularly appropriate where • Scores reflect differences that are “real”
• the availability of a large numbers of individuals for the study of certain • Scores are meaningful clinically: diagnostic and prognostic value
problems is limited and/or
• large physical functional variations among subjects falling into such categories • Quantitative methodology which requires
might confound the search for systematic treatment effects • Multiple types of analyses
• Large numbers of subjects
• Several phases and (usually) revisions

Purpose/Background Information
• Purpose: Gain information about the language and
literacy knowledge of Early Childhood Educators, parents,
and CDIS students in the GSU community
• Background: Early learning experiences determine future
LANGUAGE AND LITERACY academic success thus it is imperative that all who are in
ENRICHMENT: A COLLABORATIVE contact with children during critical years be
knowledgeable of ways to enrich language and literacy
APPROACH skills.
Jennifer Armstrong Evidence suggests that EC educators may be limited in
specific knowledge of phonological awareness,
expressive language, and general literacy skills.

Background Information con. Research Questions

• Previous study also suggests that SLPs may feel less
confident about language and literacy knowledge as it
pertains to 0-5 year olds due to limited training.
• How prepared do Early Childhood Educators perceive
themselves to be in facilitating language and literacy
enrichment activities in the classroom setting?
• How prepared do parents perceive themselves to be in
facilitating language and literacy enrichment activities in
the home environment?
• How prepared do students perceive themselves to be in
disseminating knowledge on the prevention of
disorders related to language and literacy
development?

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Research Design Outcomes

• Mixed Method Approach Outcomes will:

• Assist CDIS instructors in the structuring of graduate

• Early Childhood Professionals and Parents
-Twenty question survey with 6-point rating scale
-Four open ended questions
training programs.
• Provide an essential step in determining how best to
serve this population of children

• Students
-Twenty question survey with 6-point rating scale
-Reflective response

Background Information
• The ability to produce and comprehend complex
sentences is important to classroom success as children
progress through school

ASSESSMENT AND TREATMENT OF

• School-age children with LI continue to struggle with
GRAMMATICAL SKILLS IN OLDER grammatical skills beyond the morphosyntax level
CHILDREN
• Intervention research targeting syntax in older children is
Nicole Koonce limited (specifically complex sentence production )

Research Questions Research Design

• Given targeted intervention, do school-age children with
language impairment improve in their ability to identify,
comprehend, and produce complex sentences?
• Is improvement consistent across three targeted complex
sentence types?
• Is this improvement realized in norm-referenced and
criterion-referenced measures?
• Multiple Baseline Single Subject Design
• Baseline performance established
• Initiation of treatment results in immediate change in behavior
• Consistent demonstration of behavior change across at least two
introductions of intervention
• BSC Project
• Pre-testing: Norm-referenced, criterion-referenced, and probe
measures
• During treatment: Probe measures, Session data
• Post-testing: Norm-referenced, criterion-referenced, and probe
measures

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Treatment Schedule
Assessment Measures Adverbials 1 Adverbials 2 Adverbials 3 Adverbials 4 Adverbials 5 Adverbials 6
(time) (causal, (contrast) (condition) (concession) (mixed
Baseline 1 Baseline 2 Baseline 3 Videotape purpose) types)

•TONI3 (if needed) •Complex Sentences  •Complex Sentences 

Probe 2 (Adverbials,  Probe 3 (Adverbials,  1. Warm-up
•Complex Sentences  Object Complements,  Object Complements,  2. Lesson & practice
Probe 1 (Adverbials,  and Relatives) and Relatives)
a. ID clause (reading)
Object Complements, 
and Relatives) •GORT4 •TOWL‐3 Story  b. Deconstruction
Construction c. Combining (writing)
•CELF4 Core •Written Summarization  3. Application
Task •CASL Sentence  a. Clause Hunt
•CELF4 Working Memory  Comprehension
Subtest
4. Probe (OC, RC)

•Oral Paraphrase Task 

Pre/Post-Test Measure:
Written Summary
• SALT Transcript
If you not sleep, you will dead.
Our brain need rest.
If you not sleep for one day, you will
be sleepy and cranky.
Sleep is perfect to be better at
something.
It’s a review for the brain.
You dream many weird thing.

Measures: MLTU, SI Sleep is very important for the brain.

It’s rest for the brain.

Probe Measure: 4 - Forms one complete (complex) sentence containing the target subordinate clause (AC, RC,
or OC) which is grammatically and semantically correct.
3 - Forms one complete sentence containing the target subordinate clause which has a
Sentence Combining /Completion grammatical or semantic error
2 - Forms one complete sentence which is grammatically correct, captures the general meaning
of the two stimulus sentences, but contains a subordinate clause which is not targeted
1 - Forms one complete sentence which is grammatically correct, captures the general meaning
of the two stimulus sentences, but does not contain a subordinate clause (i.e., it is a simple
sentence) OR Forms 2 coordinated clauses
0 - Does not form a complete sentence or repeats the two stimulus sentences or sentence is
semantically untenable.

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Research-Practitioner Connections
Research situated in the context in which children receive
services
• Allows children access to new treatment approaches DEVELOPMENT AND
VALIDATION OF THE CONSENSUS
• Provides professional development to SLPs
AUDITORY PERCEPTUAL
• Encourages research and application in educational EVALUATION OF VOICE (CAPE-V)
settings Gail B. Kempster

Background to the CAPE-V Elements to the CAPE-V Protocol

• CAPE-V is a protocol to follow and form to use when
assessing perceived voice quality.
• Arose from a 2002 international consensus conference
which brought together scientists, researchers, and
clinicians
• CAPE-V drafted in 2002, disseminated (beta form) for
review, use, and feedback via D3 website
• Listen to voice in 3 contexts
• Sustained /a/ and /i/
• 6 specified sentences
• Conversation
• Evaluate voice for overall severity, roughness,
breathiness, strain, pitch, and loudness
• Other elements may be assessed

• Official protocol and form published in May 2009 in AJSLP • Measures taken on 100 mm line, with left end designated
“normal” or “none”

CAPE-V Protocol Validating an Instrument

• Reliability: degree to which judgments on the scale are
dependable or consistent within a rater or across raters
on repeated administrations.

• Validity: extent to which a scale’s scores can be

interpreted as representative of a particular underlying
construct.
• content, face, construct, criterion, empirical, convergent, predictive

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Establishing Validity Establishing Validity

• Sechrest (2005):
• “The crux of the matter lies in Messick’s assertion that
‘Validity is not a property of the test or assessment as
such, but rather of the meaning of the test scores.’ It is
not measures that are valid, but the scores that they yield
and the interpretation we make of them.”
• Empirical validity (aka concurrent validity) compares a
new instrument with another instrument that in theory
measures the same construct.
• Is one step in the process of establishing the construct
validity of a new scale.

How to validate the CAPE-V? CAPE-V Reliability and Validity

• Study supported by Div 3 (R. Zraick, PI)
• 59 voices judged a priori as normal, mild, moderate, or
severe by panel of three slps
• 21 experienced voice clinicians across the US
• Voices judged on CAPE-V and GRBAS scales
• GRBAS most common tool used world-wide
• Data analyzed for reliability and empirical validity
• Zraick, et al. 2010 published online in AJSLP
• CAPE-V ratings correlated highly with GRBAS
• All > .76
• Specifically, for the CAPE-V
• Mean intra-rater reliability ranged from .35 (Strain) to .82
(Breathiness)
• Mean inter-rater reliability ranged from .28 (Pitch) to .76
(Overall Severity)

Next Steps Roundtable Discussions

• Does training of judges help? • Panelists and members of the EBP committee are at
• Should anchor voices be used? designated tables
• Is there benefit to judging the 3 speech productions asked • Join a tableExchange research ideas, get help developing
for in the protocol? ideas into researchable questions, explore methods that
• Are the scores obtained clinically meaningful?
would be appropriate for answering clinical questions,
share experiences

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Thank You for Participating

• Fill out quick survey at back of handout and return to one
of the panelists
• Future contacts encouraged
• Catherine Balthazar c-balthazar@govst.edu
• Jessica Bonner j-bonner@govst.edu
• Stephanie Hughes s-hughes@govst.edu
• Ravi Nigam r-nigam@govst.edu