Communication Assessment Chapter 8

1. Communication AssessmentChapter 8 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 • Time spent in silence (Erber 1996; Erber 1998)

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 • Hearing tests do not allow for use of repair strategies and facilitative strategies

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 Types • Interview • Questionnaire • Daily Log • Group Discussion • Structured Communication Interaction • Unstructured Communication Interaction

11. Interviews • Basic assessment procedure to elicit specific information about an individual’s hearing related communication difficulties • Client provides subjective impressions of conversational fluency in various settings • Interviews can be structured or unstructured • “Generous listening” • Advantages • client specific information • Disadvantages • difficult to quantify information • Example interview

12. Questionnaires • Questions that probe subjective information about conversational fluency • Open-ended and close-ended questions • 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. 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

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

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

17. 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)

18. 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)

19. Active Communication Education (ACE) • Group training program to help people over the age of fifty with HL to become more effective communicators in everyday life. • program offers guidance and strategies that will help to: • Improve the person’s communication abilities • Reduce the hearing difficulties experienced • Improve the person's quality of life.

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