Communication Assessment Chapter 3

1. Communication AssessmentChapter 3 Perry C. Hanavan, Au.D.

2. Goals of Initial Assessment • Determine communication demands in everyday life • Evaluate impact of hearing loss • Identify settings where problems arise • Document social activities in which person engages • Assess effective use of communication strategies • Chronicle employment responsibilities

3. Conversational Fluency • Definition: • how smoothly conversation unfolds

4. Conversational Fluency Factors • Time spent repairing communication breakdowns • if need for clarification is low, then fluency is high • Exchange of information and ideas • is conversation easily and successfully share information, then fluency is high • Speaking time shared • equal time, few silences, few interruptions, then fluency is high

5. Index of Sharing Speaking Time • Conversational turn: • period participant delivers a contribution to a conversation • Mean length (speaking) turn (MLT) • average number of words spoken during a set number of conversational turns • Mean length turn ratio (MLT ratio) • ratio of two speakers in a conversation

6. Example 1: Conversational Fluency Teacher: Is Sarah studying at home, much? Parent: Yes, and I’m thrilled with her. Teacher: You said several weeks ago she only watched TV and used her PlayStation after school. Parent: Yes, but we have been following your suggestions of turning off the TV. Teacher MLT = 10.5 words (21 words/2 utterances) Parent MLT = 9.5 words (19 words/2 utterances) MLT ratio: 1.1 (1.0 = equal length of speaking time)

7. Example 2: Conversational Fluency Sue: Has your new furniture arrived yet? Tom: Huh? Sue: Your new furniture! Tom: Yup. (looks around and shakes head) Sue: How are you doing? How is your wife? Mary? Tom: Fine. Sue’s MLT=6 words (18 words/3 utterances) Tom’s MLT=1.0 words ( 3 words/3 utterances) MLT ratio: 6.0 (1.0=equal length speaking time)

8. Traditional Audiologic vs Conversational Fluency Measures • Most audiologic test lists present unrelated speech stimuli (spondees, PB words, etc.) • Clients usually must repeat what they hear verbatim (Say the word _____) • No interaction with communication partners

9. Problems Measuring Conversational Fluency • Varies with the conversational setting, situation, and communication partner • Varies with the topic of discussion • Communication breakdowns may not arise in the clinical setting • No one evaluation adequately measures conversational fluency

10. Assessment Procedures • Interview • Questionnaire • Daily Log • Group Discussion • Structured Communication Interaction • Unstructured Communication Interaction

11. Interviews • The client provides subjective impressions of conversational fluency in various settings • Advantages • client specific information • Disadvantages • difficult to quantify information • Example interview

12. Questionnaire • Questions that probe subjective information about conversational fluency • Advantages • quick, easy to administer • Disadvantages • may miss client-specific information

13. Questionnaire/Inventory/Survey Adults • HHI-S / HHI-A Questionnaire • SAC / SOAC Questionnaire • GHABP • SSQ • APHAB • IOI-HA • ECHO • SADL K-12 students • Listening Inventories For Educators (L.I.F.E.) • Children’s Auditory Performance Scale (CHAPS) • SIFTER • CHILD • ELF Go to www.hear2learn.com for additional surveys

14. There are a variety of outcome measures used by audiologists. An outcome measure may be address one or more outcome domains: impairment, activity, participation, satisfaction, and health-related quality of life. Some outcome measures such as pure tone thresholds, insertion gain, and audibility index (AI) are used every day and provide objective evidence of patient status. These are outcome measures in the impairment domain. Speech recognition scores (W-22, NU-6, SPIN, HINT, etc.), the Abbreviated Profile of Hearing Aid Benefit (APHAB; Cox and Alexander, 1995), Client Oriented Scale of Improvement (COSI; Dillon et al. 1997), and the Glasgow Hearing Aid Benefit Profile (Gatehouse, 1999) are examples of outcome measures in the activity domain. The APHAB, for example, asks the patient to rate the frequency he/she has problems in a specific situation: 'I have difficulty hearing a conversation when I’m with one of my family at home.' The Hearing Handicap Inventory for the Elderly (HHIE; Ventry and Weinstein, 1982), the Hearing Handicap Inventory for Adults (HHIA; Newman et al. 1991), the Abbreviated Profile of Hearing Aid Benefit (APHAB; Cox and Alexander, 1995), the Client Oriented Scale of Improvement (COSI; Dillon et al. 1997), and the Glasgow Hearing Aid Benefit Profile (Gatehouse, 1999) are outcome measures in the participation domain. For example, the HHIE asks the question 'Does a hearing problem cause you to avoid groups of people?' The Satisfaction with Amplification in Daily Life (SADL) and the ASHA Consumer Satisfaction Measure are examples of outcome measures in the satisfaction domain. For example, the SADL asks the question 'Does wearing your hearing aid(s) improve your self-confidence?' The HHIE, the Communication Profile for the Hearing Impaired (CPHI; Demorest and Erdman, 1986), the Sickness Impact Profile (SIP; Bergner et al. 1981), the MOS-36 Short Form Health Survey (Ware and Sherbourne, 1992), and the Health Utilities Index (HUI; Feeney et al. 1995) are examples of outcomes measures in the health-related quality of life domain. For example, the SF-36 asks the question 'Compared to a year ago, how would you rate your health in general now?'There are also a number of outcome measures that address the economic aspects of clinical treatment choices. Cost analysis simply measures the cost of treatment (e.g. labor, equipment, supplies, space, utilities, depreciation, overhead). It does not measure 'benefit'. Cost-benefit analysis compares dollars spent against dollars gained or saved by a treatment option. Dollar values are assigned to both the cost of treatment (cost analysis) and the costs saved, or avoided, by the treatment. For example, improved quality of life, reduced family strife, and improved employability are economic benefits to the patient. Willingness to pay analysis is a special category of cost-benefit analysis. Willingness to pay analysis obtains data on the amount individuals are willing to pay for treatment (with or without benefit). Cost effectiveness measures the cost per unit of outcome. For example, how much it cost for each percent change on the APHAB? Cost-utility analysis relates cost to changes in quality of life. One cost-utility measure is the cost per quality-adjusted life year. This measure compares cost against benefit calculated over a patient’s life expectancy.

15. Daily Log/Diary • Self-reports of behavior used by respondents for self-monitoring • Advantages • quantitative information • Disadvantages • can be a reactive process • Example daily diary

16. Group Discussion • A forum for members to discuss communication issues • Advantages • introspection and reflection • Disadvantages • reluctance to participate • Examples: Active Communication Education • discussion topics

17. Structured Communication Interaction • Simulated communication interactions • Advantage • good face validity • Disadvantage • can be time consuming to score

18. Structured Communication Interaction TOPICON • Each participant independently examinees a list of topics and indicates topics of personal interest or familiarity • One participant selects a topic for conversation from the list–reflecting personal interest, that of the other participant, or both • The client and the partner conduct a brief conversation on the chosen topic--2 to 5 minutes while the clinician evaluates the conversation (example) • Background noise, visual distractions, and/or speech and language difficulties may be introduced during the conversation, while the clinician monitors and assesses events • The participants and the clinician discuss the content and fluency of the conversation, considering avoidance or resolution of difficulties. • (Erber, 1996)

19. Structured Communication Interaction Quest?AR • Conversation-based communication therapy procedure that provides interactive practice with common question-answer sequences. • The client asks a series of questions and learns to anticipate and accurately receive spoken messages • Provides person with hearing loss confidence in asking response-limiting questions ASQUE (yes/no; choice; wh questions, etc.) • (in Erber, 1996)

20. Unstructured Communication Interaction • Spontaneous interaction with few external constraints • Free flowing conversation between patient and communication partner • Advantage • good ecological validity—mimics real-world interaction • Disadvantage • results may vary as a function of the communication partner • Example: Dyalog, ratings, transcription analysis

21. Unstructured Communication Interaction • DYALOG • Software with computer to objectively measure the fluency of conversation before, during, and after communication therapy • Observe the client in conversation (live or videotaped).  Press the "space bar" on the computer keyboard whenever misunderstanding occurs during conversation and "repair" (e.g., repetition, clarification) is needed.  Release the space bar when fluent conversation is restored.  At the end of the conversation (or after a pre-selected interval), the computer will draw a graph of conversational fluency as a function of time, and also will display: • amount of conversation time (sec) that contained breakdown/repairpercent of conversation time that contained breakdown/repairnumber of breakdown/repair eventsaverage time (sec) per breakdown/repair

22. Unstructured Communication Interaction • Ratings of conversations • Transcription analysis of conversations