What we want from therapy—measuring outcomes

This literature review examines how we’re measuring speech–language outcomes in preschoolers. They looked at 214 studies of children age birth to five, published between 2008 and 2015, and considered how the outcomes measured align with the ICF-CY (International Classification of Functioning, Disability, and Health for Children and Youth) framework.
Wait—what’s the ICF-CY? The ICF is a "framework for measuring health and disability"  and the ICF-CY is the pediatric version. It has been around since 2007, and part of the ASHA Scope of Practice (tip: here are some examples for how to consider this framework for speech sound disorders and developmental language disorders). The ICF-CY takes into account: Functioning and Disability (including Body Functions and Structures, Activities, Participation) and Contextual Factors (including Environmental Factors and Personal Factors). Here’s an example of how Functioning and Disability could be taken into account for a child with cleft palate:

  • Structures: Is the cleft repaired?
  • Functions: Is the child able to differentiate oral from nasal airflow?
  • Activities: Is the child intelligible within everyday conversations?
  • Participation: Does the child initiate conversations with peers?

OK—back to the study. So what they found is that our field is measuring outcomes with a pretty heavy bias toward activities, followed by functions, and very minimally participation. Also, we tend to measure certain skills certain ways. For example, “participation” tends to be pragmatic measures. However, as can be seen in the example above, you don’t need to have a pragmatic disorder for your communication disorder to significantly impact participation. Aren’t we worried about how speech affects participation? And how language affects participation? And that’s the point here: we’re in a habit of measuring things certain ways, but this doesn’t exactly align with the ICF-CY, and may also not align with what the child and parent are really wanting out of therapy.
So, what should we do now? First, simply becoming familiar with ICF-CY gets the ball rolling. You may quickly recognize some opportunities to change how you're measuring some clients' outcomes. Then, the authors also include entire tables of outcomes measures already available to us. You may simply look through these to brainstorm options for your caseload.
Cunningham, B.J., Washington, K.N., Binns, A., Rolfe, K., Robertson, B., Rosenbaum, P. (2017). Current Methods of Evaluating Speech-Language Outcomes for Preschoolers With Communication Disorders: A Scoping Review Using the ICF-CY. Journal of Speech, Language, and Hearing Research, 60, 447–464.