When I was a new speech language pathologist I did not have children. I was not even married. Even though I think I was a good clinician, nothing compares to the lessons I learned after I became a parent. It changed my therapy and my approach to clients both young and old.
In a recent article published in the Journal of Communication Disorders, Dr. Nancy Thomas-Stonell explores the differences between parents and speech therapists in their expectations of treatment. Specifically, the authors argue that parents’ hopes for therapy focuses on changes in the social and emotional aspects of communication while clinician’s goals focus more on medical and/or behavioral aspects; the parents want the child to be more social at preschool and the clinician’s goal is to produce complete sentences. The problem is that currently there are limited outcome measurements for the emotional, social and environmental changes of speech and language treatment, so that parents expectations, or better said what many parents really want, is often excluded from research. I know that these aspects of communication are hard to measure, but parents can measure it subjectively–and they do. When I am working with a child and I speak to a parent after a few sessions, I listen for indications of how the child is communicating with others. Usually I hear, “Even her father can understand her better”. I also want to hear if the child is getting frustrated less often. Yet, speech pathologists like to measure how many times a particular sound is used correctly or how many times a gesture is used to communicate a need during a thirty minute session. But in the real world parents want to know what their child wants and to communicate with their child and sometimes that can be hard to quantify.
The American Speech Language Hearing Association (ASHA) wants clinicians to focus on evidence based practices and be able to measure and report findings. And I believe we should as well. However, such measures should be broad enough so that they capture the emotional and social aspects of communication that are so important to parents (and to the child development!). Unfortunately, currently there are only two measures for preschool children that focus on an expanded view of therapy outcomes: the National Outcome Measure System (NOMS) and the Therapy Outcome Measures (TOMs). Dr. Thomas-Stonell argues that these measures are not comprehensive enough, that clinicians need to involve the parents more in developing their goals, and that clinician’s goals need to focus more on aspects of social and emotional communication. I could not agree more.
