Randomised Controlled Trial Evaluating Active versus Passive Waiting for Speech-Language Pathology

Abstract

<b><i>Introduction:</i></b> High demand for speech-language pathology means children sometimes wait over 12 months for services, missing out on timely support. Waiting can be a time of stress, concern, and powerlessness for caregivers. Provision of information via a website may support families and encourage active waiting. <b><i>Objective:</i></b> The aim of this study was to compare children’s speech, intelligibility, language, and literacy outcomes, and caregivers’ satisfaction and empowerment in active versus passive waiting conditions. <b><i>Methods:</i></b> Ninety-seven preschool-aged children referred to a community health speech-language pathology service in Australia were screened for eligibility. Eligible children (<i>n =</i>42) with speech/language difficulties were randomly allocated to: (a) active waiting (provision of a purpose-built website; <i>n</i> = 20), or (b) passive waiting (control group; <i>n</i> = 22). Pre- and post-assessments (after 6 months on a waiting list) were completed with children and caregivers by a speech-language pathologist blinded to group allocations. <b><i>Results:</i></b> Intention to treat (<i>n =</i>36) and per-protocol analyses (<i>n =</i>30) were conducted to measure group differences in child and caregiver outcomes at post-assessment using one-way ANCOVA, controlling for baseline scores. There were no statistically significant differences between groups for children’s speech, intelligibility, language, and literacy, or caregivers’ empowerment and satisfaction. Children in both groups made minimal gains over 6 months. <b><i>Conclusions:</i></b> Provision of an active waiting website did not lead to statistically significant change in child or caregiver outcomes, and children in both groups made little progress over a 6-month period. Early speech-language pathology intervention delivered with appropriate dosage is needed to optimise children’s outcomes. Until timely and effective speech-language pathology intervention can be provided for all who need it, provision of early assessments may be beneficial. There remains a need for effective ways to support children and families on waiting lists.

Waiting list management: Professionals’ perspectives and innovations

“…Even if therapy cannot be offered for a long time, processes are 'in motion' once an assessment is done" (160). In a recent community-based randomised controlled trial (RCT), provision of an assessment following referral to families on a speech and language therapy waiting list led to similar improvements in child outcomes and caregiver satisfaction to those who received both an assessment and access to an evidence-based speech and language website while waiting (McGill, McLeod, Ivory et al, 2021). However, Ruggero et al (2012) found that parents were dissatisfied with long waits between assessment and commencing therapy.…”

“…The results indicated that provision of advice sessions or a website to caregivers were not as effective as face-to-face therapy for improving children's speech production or caregivers' satisfaction, but there was little difference in outcomes across groups regarding children's intelligibility, language, and early literacy, and caregivers' feelings of empowerment (McLeod et al, 2020). A concurrent RCT by McGill, McLeod, Ivory et al (2021) compared two waiting list conditions: (1) provision of the same purpose-built website to caregivers; and (2) a control group involving provision of assessments only. The findings indicated that provision of a website was no more effective at improving children's and caregivers' outcomes than receiving an assessment only while waiting, suggesting families may require more than a generic website alone while waiting (McGill, McLeod, Ivory et al, 2021).…”

“…Please describe any ideas or solutions you have", and "Can you suggest any innovative ways to support children and their families and/or educators while they are waiting for speech-language pathology services?". Additionally, SLTs were asked to provide their opinion regarding how helpful and/or useful a website would be, containing information and ideas for things to do while children are waiting for speech and language services, to inform concurrent studies regarding development and evaluation of a technological waiting list management strategy (McGill & McLeod, 2019;McGill, McLeod, Ivory et al, 2021).…”

“…A concurrent RCT by McGill, McLeod, Ivory et al (2021) compared two waiting list conditions: (1) provision of the same purpose-built website to caregivers; and (2) a control group involving provision of assessments only. The findings indicated that provision of a website was no more effective at improving children's and caregivers' outcomes than receiving an assessment only while waiting, suggesting families may require more than a generic website alone while waiting (McGill, McLeod, Ivory et al, 2021).…”

Comparing In-Person and Telepractice Service Delivery for Spoken Language Production and Comprehension Using the National Outcomes Measurement System

“…Additionally, the lack of licensing portability across states, despite national accreditation standards and certification requirements, has impeded widespread adoption of telepractice services ( Jakubowitz, 2011 ). It is well-known that delayed or lack of services negatively impacts young and school-age children's development and education ( McGill et al, 2020 ). Although telepractice has been proposed as a potential means of reaching unserved or underserved populations ( Doarn et al, 2010 ), the approach remains underutilized ( Lowman & Kleinert, 2017 ).…”