Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Doctor of Philosophy


Health and Rehabilitation Sciences


Cardy, Janis


It has been estimated that speech and language disorders impact as many as 15-22% of preschoolers. In Ontario, Canada, families who are concerned about their children’s speech, language, or communication skills can access publicly funded services through Ontario’s Preschool Speech and Language Program. In this program, speech-language pathologists provide assessments and early interventions to improve children’s communication skills and lessen the negative effect of communication delays on development. Since 2012, the Program mandated the use of an outcome measure, the Focus on the Outcomes of Communication Under Six® (FOCUS), but there has been inconsistent uptake among speech-language pathologists. Using a practice-based research approach, this dissertation explores issues related to outcome measurement within the Preschool Speech and Language Program in Ontario through several studies. Study 1 explored the potential uses of the FOCUS data collected within a real-world clinic. Study 2 engaged speech-language pathologists across Ontario to investigate the facilitators and barriers related to the implementation of the FOCUS. Study 3 engaged relevant stakeholders (speech-language pathologists, policy makers, researchers who developed the FOCUS tool) to identify practical ways to resolve the implementation challenges. Results of these studies indicate that the collected outcomes data offer a way to demonstrate intervention effectiveness and to understand predictors of children’s outcomes. Barriers within practice, however, are currently impeding speech-language pathologists’ capacity and motivation to fully implement the FOCUS into routine practice. Practical implementation strategies that balance the perspectives of relevant stakeholders were selected to resolve the practice barriers. The methodologies and findings of this dissertation inform outcome measurement improvement across all health and rehabilitation disciplines.

Summary for Lay Audience

In Ontario, Canada, families who are concerned about their children’s speech, language or communication skills can get assessments and treatments from speech-language pathologists from Ontario’s Preschool Speech and Language Program at no charge. Being able to track children’s growth in this program is very important. In 2012, the Program asked speech-language pathologists to use the Focus on the Outcomes of Communication Under Six® (FOCUS) to monitor children’s growth. This dissertation includes three studies. Study 1 looked at children’s growth in a free parent training program called Target Word. The data from the FOCUS shows that most children made clinically significant gains during the Target Word program. In study 2, speech-language pathologists across Ontario shared their experience using the FOCUS. They identified three major factors that are currently limiting data collection using the FOCUS. In Study 3, speech-language pathologists, policy makers, and researchers worked together to identify practical ways to improve the regular use of the FOCUS. Overall, this dissertation looked at issues surrounding the outcome monitoring system in Ontario’s Preschool Speech and Language Program in order to improve the services offered to children and their families.