Speech and language therapy for adolescents in youth justice: A series of empirical single-case studies.

BACKGROUND: Adolescents in contact with youth justice are a vulnerable and marginalized group at high risk of developmental language disorder (DLD) and other communication difficulties. Though preliminary studies have demonstrated the benefits of speech and language therapy (SLT) services in youth justice, limited research has empirically tested the efficacy of intervention in these settings. AIMS: To evaluate the extent to which intensive, one-to-one language intervention improved the communication skills of incarcerated adolescents with below-average (> 1 SD below the mean) language and/or literacy skills. METHODS & PROCEDURES: A series of four empirical single case studies was conducted, using multiple baseline intervention design. Individualized intervention programmes were administered, and progress on outcome measures (probes) was evaluated throughout the baseline, intervention and maintenance phases using Tau-U, a non-parametric distribution-free statistic. Additional measures were used as secondary outcomes of the intervention, including standardized language subtests, subjective rating tools by participants and their teachers collected pre- and post-intervention, and a brief structured participant interview, independently administered by youth justice staff. OUTCOMES & RESULTS: Medium-to-large effect sizes, the majority of which were statistically significant, were detected on the primary outcome measure across the four cases, indicating improvements in the targeted communication skills. Positive results were also evident in comparisons of pre- and post-measures on standardized language subtests, subjective self- and teacher ratings of communication, and the participants' impressions of the interventions. For those participants who could be followed up, gains in language skills were generally maintained at 1 month post-intervention. CONCLUSIONS & IMPLICATIONS: This study provides further evidence of the efficacy of one-to-one SLT intervention for adolescents in youth justice in order to address language and literacy difficulties. These findings inform future SLT service provision for adolescents in these settings, with clear policy and practice implications. Future research should investigate the wider benefits to individuals' engagement in youth justice intervention and recidivism, as well as assessing maintenance of gains over a longer period. What this paper adds What is already known on this subject The high rates of DLD in youth justice is well known, with difficulties spanning multiple areas of language and literacy. SLTs are increasingly working in community and custodial youth justice settings, and a few preliminary studies have demonstrated the effectiveness of such work. What this paper adds to existing knowledge This study extends the evidence base of the efficacy of SLT for language and literacy difficulties in youth justice, using a series of four empirical single case studies. It is also argued that SLT should be more actively considered in planning multidisciplinary interventions for young people in custody. What are the potential or actual clinical implications of this work? The results of this research support current moves to include SLT services in youth justice systems, and illustrate for clinicians currently working in this sector a way of structuring and measuring the impact of intervention services.

Is satisfaction with surgeon a determining factor in patient reported outcomes in breast reconstruction?

BACKGROUND: Patient reported outcomes are increasingly being taken into account in planning health service provision. Few studies have examined how the process of care influences patients' perception of outcome. The aim of the current study was to quantify patient satisfaction with breast reconstruction and to examine the demographic, disease and process-of-care variables that contributed to satisfaction with breasts and overall outcome. METHODS: A cross-sectional study was designed and the BREAST-Q outcomes assessment instrument was used to evaluate patient-reported psychosocial, physical and sexual well-being, as well as satisfaction with breasts, overall outcome and process of care. To identify factors predictive of satisfaction with breasts and overall outcome, the relation between covariates and each of these scales was assessed using linear regression models. RESULTS: Sixty one patients, with a mean age of 50 years, completed the survey. Mean satisfaction with breasts was 59.6% and satisfaction with overall outcome was 73.2%. Satisfaction across health-related quality of life scales ranged from 44.6% for sexual well-being to 74.6% for physical well-being. The mean rating for psychosocial well-being was 67.9%. Satisfaction ratings for surgeon, medical staff and office staff were all over 90%. Satisfaction with plastic surgeon was predictive of satisfaction with outcome and satisfaction with breasts (P = 0.001 and 0.021 respectively). DISCUSSION: The surgeon-patient relationship significantly influences patient reported outcomes in breast reconstruction. Further service development must recognize the need for additional time and personnel to deliver high standard, patient-centered care.

Language and reading instruction in early years' classrooms: the knowledge and self-rated ability of Australian teachers.

This study sought to investigate the level of knowledge of language constructs in a cohort of Australian teachers and to examine their self-rated ability and confidence in that knowledge. Seventy-eight teachers from schools across the Australian state of Victoria completed a questionnaire which included items from existing measures, as well as newly developed items. Consistent with a number of earlier Australian and international studies, teachers' explicit and implicit knowledge of basic linguistic constructs was limited and highly variable. A statistically significant correlation was found between (1) total self-rated ability and (2) years since qualification and experience teaching the early years of primary school; however, no relationship was found between self-rated ability and overall performance on knowledge items. Self-rated ability to teach phonemic awareness and phonics had no relationship with demonstrated knowledge in these areas. Teachers were most likely to rate their ability to teach skills including spelling, phonics, comprehension or vocabulary as either moderate or very good. This was despite most respondents demonstrating limited knowledge and stating that they did not feel confident answering questions about their knowledge in these areas. The findings from this study confirm that in the field of language and literacy instruction, there is a gap between the knowledge that is theoretically requisite, and therefore expected, and the actual knowledge of many teachers. This finding challenges current pre-service teacher education and in-service professional learning.

Improving communication outcomes for young offenders: a proposed response to intervention framework.

BACKGROUND: Speech, language and communication needs (SLCN) are strongly overrepresented in young offender populations, and there is growing commitment internationally to ensuring access to speech-language therapy services for such young people. However there is currently no framework in which such interventions might be conceptualized, delivered and evaluated. This is significant given the role of language competence in the development of prosocial skills and also in the transition to literacy. AIMS: To present Response to Intervention (RTI) as a framework in which SLCN of young offenders might be systematically addressed and evaluated within youth justice settings, led by speech-language therapists, in conjunction with other education and welfare team members. METHODS & PROCEDURES: Literature regarding prevalence rates of SLCN in young offenders is reviewed, together with the limited extant evidence on interventions for this group. The importance of applying evidence-based interventions is argued, and a framework for adapting RTI for SLCN in custodial settings is outlined. MAIN CONTRIBUTION: A framework for adapting RTI to design, deliver and evaluate speech-language therapy interventions in youth custodial settings is presented. CONCLUSIONS: Speech-language therapy interventions for young offenders will be better addressed at policy, practice and research levels if a framework such as an RTI adaptation is employed. It is expected, however, that this model will evolve over time, as intervention evidence pertaining to the youth offender population emerges.

Oral language supports early literacy: a pilot cluster randomized trial in disadvantaged schools.

This study examined the impact of teacher professional development aimed at improving the capacity of primary teachers in disadvantaged schools to strengthen children's expressive and receptive oral language skills and early literacy success in the first 2 years of school. Fourteen low-SES schools in Victoria, Australia were randomly allocated to a research (n = 8) or control arm (n = 6), resulting in an initial sample of 1254 students, (n = 602 in research arm and n = 652 in control arm). The intervention comprised 6 days of teacher and principal professional development (delivered by language and literacy experts), school-based continuing contact with the research team and completion by one staff member of each research school of a postgraduate unit on early language and literacy. Schools in the control arm received standard teaching according to state auspiced curriculum guidelines. Full data were available on 979 students at follow-up (time 2). Students in the research arm performed significantly better on Test of Language Development: Primary (Fourth Edition) sub-tests (p ≤ .002) and the Reading Progress Test (F = 10.4(1); p = .001) than students in the control arm at time 2. Narrative scores were not significantly different at time 2, although students in research schools showed greater gains. Findings provide "proof of concept" for this approach, and are discussed with respect to implications for teacher professional development and pre-service education concerning the psycholinguistic competencies that underpin the transition to literacy.

Monolingual versus multilingual acquisition of English morphology: what can we expect at age 3?

BACKGROUND: At least two-thirds of the world's children grow up in environments where more than one language is spoken. Despite the global predominance of multilingualism, much remains unknown regarding the language acquisition of children acquiring multiple languages compared with monolingual children. A greater understanding of multilingualism is crucial for speech-language pathologists given the increasing number of children being raised in linguistically diverse environments. AIMS: To investigate the expressive morphological abilities of multilingual children acquiring English, compared with monolingual children, at 3 years of age. METHODS & PROCEDURES: Participants were 148 children (74 multilingual children; 74 matched monolingual children; mean age of 3 years 4 months) already participating in a larger prospective longitudinal cohort study of language development in Melbourne, Australia. Thirty-one languages in addition to English were represented within the embedded cohort. All participants completed a direct language assessment to measure their expressive abilities across a range of English morphemes. The parents of the multilingual participants completed an interview regarding the children's language backgrounds and experiences. OUTCOMES & RESULTS: The Multilingual Group typically performed below the Monolingual Group in terms of their accurate use and mastery of English morphemes at 3 years of age, although variable expressive abilities were indicated within each group. The same morphemes were shown to be mastered by relatively higher proportions of each group. Likewise, the same forms were mastered by relatively lower proportions of each group. The results indicated similarities between the children's acquisition of English morphology, regardless of whether they were acquiring English only or in combination with another language(s) at 3 years of age. CONCLUSIONS & IMPLICATIONS: This study found a range of similarities and differences between multilingual compared with monolingual children's acquisition of English morphology at 3 years of age. The findings have important implications for researchers and clinicians involved in the management of linguistically diverse populations by advancing knowledge of early multilingual English morpheme acquisition and building awareness of acquisition patterns among multilingual and monolingual English-speaking children at 3 years of age.

Full thickness burn caused by exposure to giant hogweed: delayed presentation, histological features and surgical management.

We report the case of a 10-year-old boy with a full thickness chemical burn on his right pretibial area due to phytophotodermatitis (PPD) following contact with giant hogweed (Heracleum mantegazzianum). Although cutaneous burns due to plants are a well-established cause of chemical burn, previous reports described partial thickness burns that healed with conservative measures. This patient presented to our unit two weeks after the initial injury with an established full thickness burn. Debridement and split thickness skin grafting was required. We presented the histological features of the debrided skin specimen and discussed potential factors leading to this unexpected full thickness injury.

The human bite injury: a clinical audit and discussion regarding the management of this alcohol fuelled phenomenon.

BACKGROUND: Human bite injuries are both deceptive and challenging in their presentation and management. They remain a frequent presentation to our unit, most often following late night alcohol fuelled aggression. AIMS: To audit the management of these wounds, with particular focus on infective complications and outcomes. METHODS: A three year retrospective chart review was undertaken on all patients referred to the plastic surgery unit from 1 January 2003 through to 31 December 2005. RESULTS: A total of 92 patients with 96 human bite wounds were identified. The majority were male (92%). Alcohol consumption was documented in 86% of cases. The majority (70%) occurred over the weekend or on a public holiday. Facial injuries made up 70% of injuries with the remainder being to the upper limb. The ear was the most common target of all facial injuries (65%). Infection was documented in 18 cases (20%), with bite injuries to the upper limb and those presenting late (>12 h) having a higher incidence of infection. CONCLUSIONS: Human bite wounds present a challenge to any emergency department, given the many issues involved in their management. Underestimation of the complexity and potential sequelae of these wounds will result in a suboptimal outcome for the patient.

Prospective evaluation of outcome measures in free-flap surgery.

Free-flap failure is usually caused by venous or arterial thrombosis. In many cases, lack of experience and surgical delay also contribute to flap loss. The authors prospectively analyzed the outcome of 57 free flaps over a 28-month period (January, 1999 to April, 2001). The setting was a university hospital tertiary referral center. Anastomotic technique, ischemia time, choice of anticoagulant, and the grade of surgeon were recorded. The type of flap, medications, and co-morbidities, including preoperative radiotherapy, were also documented. Ten flaps were re-explored (17 percent). There were four cases of complete flap failure (6.7 percent) and five cases of partial failure (8.5 percent). In patients who received perioperative systemic heparin or dextran, there was no evidence of flap failure (p = .08). The mean ischemia time was similar in flaps that failed (95 +/- 29 min) and in those that survived (92 +/- 34 min). Also, the number of anastomoses performed by trainees in flaps that failed (22 percent), was similar to the number in flaps that survived (28 percent). Nine patients received preoperative radiotherapy, and there was complete flap survival in each case. This study reveals that closely supervised anastomoses performed by trainees may have a similar outcome to those performed by more senior surgeons. There was no adverse effect from radiotherapy or increased ischemia time on flap survival.