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RehabMeasures Instrument

Focus on the Outcomes of Communication Under Six

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Purpose

Clinician and parent/guardian evaluation form that measures a child’s change in communicative participation over time following speech-language therapy. The questionnaire is intended to capture communicative participation in natural contexts.

It is used as an outcome measure to capture change after speech-language therapy intervention.

Link to Instrument

Instrument Details

Acronym FOCUS

Area of Assessment

Assertiveness
Communication
Language
Life Participation
Occupational Performance
Processing Speed
Reasoning/Problem Solving
Self-efficacy
Social Relationships
Social Support
Word Finding

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$0.00

Cost Description

$99 CAD

The manual and scoresheets can be purchased through CanChild at the following link:
https://canchild.ca/en/shop?utf8=✓&filters%5bkeywords%5d=focus&commit=Search

Diagnosis/Conditions

  • Pediatric + Adolescent Rehabilitation

Key Descriptions

  • ● The FOCUS can be completed by a parent/guardian or a speech-language pathologist.
    ● The preference is for the FOCUS to be completed by a parent or other adult who is very familiar with the child.
    ● The clinician should review the items with the parent/guardian to ensure understanding before completing the measure.
    ● If the FOCUS is administered by the clinician, then consultation with parent/guardian is highly recommended.
    ● It can be administered at initial assessment, at the start/end of treatment periods, and during reassessments.
    ● All 50 items should be completed for proper scoring.
    ● If more than 2 items are missed, a total score cannot be calculated.
    ● Each item is scored on a scale from 1 to 7
    ● Scoring can be done manually or through the FOCUS Excel Scoring Sheet
    ● Total scores can range from 50 to 350. The manual outlines change scores that indicate clinical change.

Number of Items

50

Equipment Required

  • FOCUS assessment manual
  • Scoring sheet (electronic or paper)
  • Computer, pen, or phone

Time to Administer

10 minutes

Required Training

Reading an Article/Manual

Age Ranges

Infant

- 2

years

Preschool Children

2 - 5

years

Instrument Reviewers

Lindsay MacCary, BA, OTS, University of Illinois at Chicago

Amanda Pineda, BS, OTS, University of Illinois at Chicago

Sydney Warren, BSW, OTS, University of Illinois at Chicago

ICF Domain

Activity
Participation

Measurement Domain

Cognition
Motor

Considerations

It can be completed with paper and pencil or on a computer using a fillable PDF. Clinicians can also administer the FOCUS to a parent/guardian over the phone and record the answers on paper or on the fillable PDF. There is an audio version of the FOCUS to assist parents/guardians who prefer it.

 

  • Ideally, the same parent/guardian or clinician completes the measure at each administration
  • Children with parents of higher socioeconomic status and education level typically show better communication participation scores. This should be taken into consideration when working with children with varying socioeconomic and parental educational backgrounds.
  • Ideally, the time between administration points should be at least 6 months

Pediatric Disorders

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Minimally Clinically Important Difference (MCID)

Children under six with speech and language impairments:

(Thomas-Stonell et al., 2013b; n = 27; mean age = 2.8 (0.92) years; Communication Function Classification Scale (CFCS) Level 1 = 7%, Level 2 = 19%, Level 3 = 19%, Level 4 = 44%, Level 5 = 11%)

  • MCID= 25.3 points, t = 3.2, p < 0.01

 

(Thomas-Stonell et al., 2013a; n = 97; mean age = 2.7 (1.04) years; CFCS Level 1 = 7 (7%), Level 2 = 8 (8%), Level 3 = 16 (16%), Level 4 = 44 (45%), Level 5 = 22 (23%))

  • MCID established as a change ≥ 16 FOCUS points
  • MCID post speech-language therapy = 18.2 points, t = 5.62, p < 0.001

 

(Washington et al., 2015; n = 26; 65% speech-language impairments; 12% language impairments; 10% speech impairments)

  •  MCID = 32.56 score units (p < 0.001)

 

Children under six with speech and language impairments and mobility impairments:

(Washington et al., 2015; n = 20; cerebral palsy, n = 10; hypotonia, n = 2; clubfoot, n = 2; global developmental delay, n = 2; spina bifida, n = 3; spinal cord tumour; 55% speech-language impairments; 35% language impairments; 15% speech impairments)

  • MCID = 20.06 score units (p < 0.001)

 

Children under six with language impairments only:

(Thomas-Stonell et al., 2013b; n = 62; mean age = 2.4 (0.78) years; CFCS Level 1 = 5%, Level 2 = 2%, Level 3 = 7%, Level 4 = 51%, Level 5 = 35%)

  • MCID = 18.2 points, t = 5.2, p < 0.01

 

Children under six with speech impairments only:

(Thomas-Stonell et al., 2013b; n = 23; mean age = 3.75 (0.78) years; CFCS Level 1= 17%, Level 2 = 17%, Level 3 = 35%, Level 4 = 30%)

  • MCID = 18.3 points, t = 3.4, p < 0.01

Test/Retest Reliability

Children under six with speech and language impairments: (Thomas-Stonell et al., 2009; n = 165; mean age = 3.8 (0.91))

 

Parent:

  • Excellent (r > 0.95)

Clinician:

  • Adequate (r > 0.70)

 

Children under six with speech impairments only:

 

FOCUS-G (FOCUS Germany)

(Neumann et al., 2017; n = 226, mean age = 4.6 (0.84), CFD [children with fluency disorder], n = 30; CCPS, n = 35; CCPS [children with cleft palate speech], n = 23; CSSD [children with speech sound disorder], n = 45; TDC [typical developing children], n = 151; German speaking)

 

Parent:

  • Excellent test-retest reliability (ICC = [.95, .99])

Interrater/Intrarater Reliability

Children under six with speech and language impairments:

(Oddson et al., 2013; n = 13; Mean Age = 57 mo.)

Clinician:

  • Adequate interrater reliability within a 2.5 month period (ICC = 0.70)

 

(Thomas-Stonell et al., 2009)

Clinician:

    Pre-treatment

  • Adequate interrater reliability for Part I (r > 0.70)
  • Adequate interrater reliability for Part II (r = 0.51)

 

(Thomas-Stonell et al., 2013a)

Parent and SLP:

  • Excellent interrater reliability (n = 88; Time 1 ICC = 0.78; Time 2, ICC = 0.78; Time 3, ICC = 0.85)

Internal Consistency

Children under six with speech and language impairments: (Thomas-Stonell et al., 2009)

Phase I:

    Parents

  • High: Cronbach’s alpha = 0.87
  • Low (only for parents’ responses for the strongly agree ⁄strongly disagree response): Cronbach’s alpha = 0.51

    Clinicians

  • High: Cronbach’s alpha = 0.97

Phase II:

    Parents

  • High: Cronbach’s alpha = 0.98

    Clinicians

  • High: Cronbach’s alpha = 0.83

Phase III:

    Pre-treatment   

        Parents

  • High: Cronbach’s alpha = 0.96

        Clinicians

  • High: Cronbach’s alpha = 0.97

    Post-treatment

        Parents

  • High: Cronbach’s alpha = 0.96

        Clinicians

  • High: Cronbach’s alpha = 0.94

 

 

Children under six with speech impairments only:

FOCUS-G (FOCUS Germany)

(Neumann et al., 2017; German speaking)

Parents:

  • Excellent: Cronbach’s alpha = 0.959

 

 

 

SPLIT-HALF RELIABILITY

Children under six with speech impairments only:

FOCUS-G (FOCUS Germany)

(Neumann et al., 2017; German speaking)

  • Adequate: r = 0.83; r SH  = 0.91

Construct Validity

Children under six with speech and language impairments:

(Thomas-Stonell et al., 2009)

  • Adequate correlation with PedsQL (r = 0.488)

 

(Washington et al., 2013; n = 52, mean age = 4 years 6 (8.6) months; pre-post design)

  • Correlations between FOCUS and VABS-II
    • Adequate correlation between Communication domain total scores pre-test (r = 0.53) post-test (r = 0.53)
    • Adequate correlation between Communication domain changes over time (r = 0.45)
    • Excellent correlation between Socialization domain total scores pre-test (r = 0.67) and Adequate correlation post-test (r = 0.37)
    • Adequate correlation between Socialization domain changes over time (r = 0.39)

 

(Thomas-Stonell et al., 2013a)

  • Correlation between FOCUS and ASQ-SE
    • Poor correlation between change measured in ASQ-SE communication questions and FOCUS change scores; r = 0.232 (p = 0.016)
    • Poor correlation between change measured in ASQ-SE non-communication questions and FOCUS change scores; r = 0.175 (p = 0.088)
    • Poor correlation between ASQ-SE Self-regulation domain and FOCUS change scores; r = 0.02 (p = 0.86)
    • Poor correlation between ASQ-SE Autonomy domain and FOCUS change scores; r = 0.12 (p = 0.27)
    • Poor correlation between ASQ-SE Interaction with people domain and FOCUS change scores; r = 0.13 (p = 0.22)
    • Poor correlation between ASQ-SE Adaptive functioning domain and FOCUS change scores; r = 0.19 (p = 0.06)
    • Poor correlation between ASQ-SE Compliance domain and FOCUS change scores; r = 0.21 (p = 0.02)
    • Poor correlation between ASQ-SE Affect domain and FOCUS change scores; r = 0.29 (p = 0.02)
    • Adequate correlation between ASQ-SE Communication domain and FOCUS change scores; r = 0.40 (p = 0.001)

 

Children under six with speech impairments only:

FOCUS-G (FOCUS Germany)

(Neumann et al., 2017; German speaking)

  • Correlation between FOCUS-G and KiddyKINDL
    • Adequate correlation with KiddyKINDL; r = 0.499
  • Correlation between FOCUS-G subdomain average scores
    • Excellent correlation amongst the 9 FOCUS-G subdomain average scores and the total score ranging from r = 0.61-0.93
    • Adequate correlation with the mean value of social interactive subdomains (Emotional Well-Being, Self-Esteem, Friends, Preschool/Kindergarten, Parents) in the KiddyKINDL; r = 0.414
    • Discriminant Validity - Poor correlation with the Physical Well-Being and Family subscales of the KiddyKINDL; r = 0.179
  • Correlation between FOCUS-G subdomain average scores and external criteria
    • Poor correlation between FOCUS-G subdomain average scores and family’s socioeconomic status; r = 0.18-0.30 (p < 0.01)
    • Poor- Adequate correlation between FOCUS-G subdomain average scores and mother’s level of education; r = 0.25-.35 (p < 0.01)
    • Poor correlation between FOCUS-G capacity: speech subdomain average scores and gender; r = 0.19 for girls (p < 0.05)
    • Poor correlation between FOCUS-G performance: social/play subdomain average scores and gender; r = 0.13 for girls (p < 0.05)

 

  • Discriminatory Ability
    • Effective discrimination between mean scores for the

TDC and CSI groups (TDC group; M = 6.03, CSI group; M = 5.47, p < 0.001)

Content Validity

Children under six with speech and language impairments:

  • A content analysis was completed on comments from parents and clinicians of 210 preschool children who attend speech-language therapy (Thomas-Stonell et al., 2009)
  • Items were initially included if they fell into an ICF domain that was cited by at least 10% of parents and clinicians interviewed (Thomas-Stonell et al., 2009)
  • Items were then pre-tested and revised several times (Thomas-Stonell et al., 2009)

Bibliography

CanChild. (n.d.). FOCUS. Retrieved from https://canchild.ca/en/shop

/29-focus

 

Neumann, S., Salm, S., Rietz, C., & Stenneken, P. (2017). The German Focus on the Outcomes of Under Six (FOCUS-G): Reliability and validity of a novel assessment of communication participation. Journal of Speech, Language, and Hearing Research, 60, 675-681.

 

Oddson, B., Washington, K., Robertson, B., Rosenbaum, P., & Thomas-Stonell, N. (2013). Inter-rater reliability of clinicians’ ratings of preschool children using the FOCUS©: Focus on the Outcomes of Communication Under Six. Canadian Journal of Speech-Language Pathology & Audiology, 37(2), 170-174.

 

Thomas-Stonell, N., Oddson, B., Robertson, B., & Rosenbaum, P. (2009). Development of the FOCUS (Focus on the Outcomes of Communication Under Six), a communication outcome measure for preschool children. Developmental Medicine & Child Neurology, 52, 47-53.

 

Thomas-Stonell, N., Robertson, B., Walker, J., Oddson, B., Washington, K., & Rosenbaum, P. (2012). FOCUS: Focus on the Outcomes of Communication Under Six. Retrieved from https://research.hollandbloorview.ca/Assets/FOCUS_FOCUS-34%20Manual.pdf

 

Thomas-Stonell, N., Oddson, B., Robertson, B., Rosenbaum, P. (2013a). Validation of the Focus on the Outcomes of Communication under Six outcome measure. Developmental Medicine & Child Neurology, 55(6), 546-552. doi: 10.111/dmcn.12123

 

Thomas-Stonell, N., Washington, K., Oddson, B., Robertson, B., & Rosenbaum, P. (2013b). Measuring communicative participation using the FOCUS: Focus on the Outcomes of Communication Under Six. Child: Care, Health and Development, 39(4), 474-480. doi: 10.1111/cch.12049

 

Washington, K., Thomas-Stonell, N., Oddson, B., McLeod, S., Warr-Leeper, G., Robertson, B., Rosenbaum, P. (2013). Construct validity of the FOCUS (Focus on the Outcomes of Communication Under Six): a communicative participation outcome measure for preschool children. Child: Care, Health and Development, 39(4), 481-489. doi: 10.1111/cch.12043

 

Washington, K.N., Thomas-Stonell, N., McLeod, S., & Warr-Leeper, G. (2015). Outcomes and predictors in preschoolers with speech-language and/or developmental mobility impairments. Child Language Teaching and Therapy, 31(2), 147-157. 

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