Development of the FOCUS (Focus on the Outcomes of Communication Under Six), a communication outcome measure for preschool children

Abstract

AIM Our aim was to develop an outcome measure, called Focus on the Outcomes of Communication Under Six (FOCUS), that captures real-world changes in preschool children's communication. Conceptually grounded in the World Health Organization International Classification of Functioning, Disability and Health framework, the FOCUS items were derived from observations of change provided by parents and clinicians after speech-language therapy.METHOD Participating families (n=165) were drawn from a convenience sample at partner institutions in Ontario, Newfoundland and Labrador, and Nova Scotia. All children had speech, language comprehension, and ⁄ or language production disorders and were receiving speech-language therapy. The age of the children ranged from 1 year 2 months to 5 years 6 months (mean=3.8y; SD=0.91y), and 119 children were male. Three test phases were completed. The measure was revised according to item analysis and parent ⁄ clinician feedback after phase 1 (n=74) and phase 2 (n=65). In phase 3 (n=26), the Pediatric Quality of Life Inventory (PedsQL), a health-related quality of life measure, was added to establish construct validity. RESULTSIn phase 1, item analysis revealed high internal consistency for both parents (Cronbach's a=0.87) and clinicians (Cronbach a=0.97). These values indicated redundancy, so 31 items were cut. Five items for young children were added. In phase 2, internal consistency remained high for both parents (Cronbach a=0.98) and clinicians (Cronbach a=0.83), indicating redundancy of items. Twenty-seven items were removed. In phase 3, parents and clinicians reliably scored the FOCUS in 10 minutes. They stated that it provided an accurate snapshot of the child's communication.Internal consistency for parents remained high (Cronbach a=0.96). Children with higher FOCUS scores at the end of treatment had higher PedsQL total scores (r=0.466, p=0.029). INTERPRETATIONThe FOCUS is a usable measure of a child's ability to communicate and participate in his or her community. It demonstrates high internal consistency and construct validity.Approximately 6% of preschool children have significant communication disorders.1 By the age of 3 years, these children are being socially isolated and ignored by their peers.2-4 In later years, communication disorders are associated with social isolation, academic failure, and an increased incidence of psychiatric disorders and arrests. 5,6 Effective and early speechlanguage therapy is critical to preventing these problems. 7,8 Evaluating the outcomes of treatment is essential for improving services in an evidence-based manner. 10 This revised framework was multidirectional, acknowledging that interventions at all levels are important and interlinked. 11,12 The ICF for Children and Youth (ICF-CY), a paediatric version of the ICF, was published in 2007. 13 These frameworks facilitated a shift in health care paradigms, empowering clinicians to set treatment goals that focus on participation in life situations. [14][15][16][17][18] To capture the real-w...

Evidence-based intervention for preschool children with primary speech and language impairments: Child Talk – an exploratory mixed-methods study

“…283 There are two tools based on this that have been developed to capture information specifically in relation to communication. They are the TOMs 275 and the Focus on the Outcomes of Communication Under Six (FOCUS) measure, 299 either of which would be appropriate. Again, further consensus work is required with the profession.…”

Promoting consistent use of the communication function classification system (CFCS)

“…Recently, the PSLP adopted two new tools to be used with all preschoolers accessing the program each year. The Focus on the Outcomes of Communication Under Six (FOCUSß) [2], and the Communication Function Classification System (CFCS) [3], address how communication issues affect children's social functioning and participation, and classify levels of communicative functioning, respectively. The FOCUSß is a validated parent-report measure that captures changes in children's communicative participation [4]; the CFCS is a validated classification system that allows clinicians and families to classify children's communication skills into one of five levels of function [3].…”

Construct validity of the FOCUS© (Focus on the Outcomes of Communication Under Six): a communicative participation outcome measure for preschool children

“…2009). For the original development of the FOCUS © , information on children's abilities to communicate and participate in his or her community was gathered for 375 preschoolers.…”

“…using words and sentences to join in conversations with others) in children's communication associated with speech-language intervention (Thomas-Stonell et al . 2009). Unlike the SPAA-C (McLeod 2004), the FOCUS © was designed to be used with a variety of children with speech and language impairments, and not only those identified with speech impairments.…”

“…The reliability of the FOCUS © is established (Thomas-Stonell et al . 2009; Washington et al . 2013).…”