Supporting Children with Complex Communication Needs to Communicate Choices During an Inpatient Stay: Effect of a Partner Training on Health Care Professionals
Open Access
- Author:
- Gormley, Jessica
- Graduate Program:
- Communication Sciences and Disorders
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- July 04, 2019
- Committee Members:
- Janice Catherine Light, Dissertation Advisor/Co-Advisor
Janice Catherine Light, Committee Chair/Co-Chair
Jessica Gosnell Caron, Committee Member
Nicole Michele Etter, Committee Member
David Brent Mcnaughton, Outside Member - Keywords:
- augmentative and alternative communication
health care training
just-in-time training
inpatient
communicating choices
children - Abstract:
- Children with complex communication needs (e.g., children with developmental or acquired disabilities whose speech is inadequate to meet their communication needs) often experience extensive and/or repeated hospitalizations in early childhood (Burns et al., 2010) thus making the inpatient setting an environment likely to influence their communication and language development. Unfortunately, previous research suggests that inpatient settings often do not present an optimal environment to promote these developmental processes. These settings are frequently characterized by limited child-directed speech and limited opportunities for children to actively participate in health care routines (Caskey et al., 2014; Gormley & Light, 2019a). Further, heath care providers are seldom equipped with the knowledge and skills to support child participation in these interactions due to time constraints, busy schedules, and lack of specialized augmentative and alternative communication (AAC) trainings (Gormley & Light, 2019a). The development of AAC trainings that effectively and efficiently equip health care professionals to interact with children who have complex communication needs is urgently warranted to optimize immediate communication effectiveness and to promote language development. In this study, a pretest-posttest experimental group design (Campbell & Stanley, 1963) was used to evaluate the effects of an AAC partner training designed to teach health care providers a procedure to support children to communicate choices. This training, delivered via a mobile app, taught a procedure comprised of components known to support child participation and language development (i.e., offer a choice, wait for a response, respond to the child). The training format was designed to change provider performance within real-world contexts and used: (a) procedural instruction, (b) just-in-time elements, and (c) a checklist to support the instructional process. Participant performance was evaluated within child-provider interactions during naturally-occurring inpatient routines. Interactions were videotaped and coded to measure the effects of the training on the number of providers who offered a choice to the child participant and the accuracy with which the trained procedure was implemented. After completing the training, ten of the 14 (71%) participants in the treatment group offered choices to children with complex communication needs during inpatient interactions. These individuals also demonstrated improved accuracy completing the procedure after completing the training. The children successfully communicated their choices within 15 of the 16 posttest interactions (94%) when providers offered a choice and this process took, on average, less than one minute to complete. This study serves as an important step toward improving child-provider interactions in the inpatient setting by equipping health care providers with the skills necessary to consistently support the active participation of children with complex communication needs and to engage in responsive caregiving practices. This is the first AAC training designed to promote effective child-provider interactions in inpatient settings that demonstrates results that are effective, efficient, and socially valid in a real-world context. The development of AAC partner trainings that incorporate instructional design techniques like those used in this study (i.e., procedural instruction, just-in-time training elements, checklist) may also effectively teach providers to engage in other procedures that ultimately support the participation of children with complex communication needs in health care interactions in a developmentally-appropriate manner.