Augmentative and Alternative Communication
ISSN: 0743-4618 (Print) 1477-3848 (Online) Journal homepage: http://www.tandfonline.com/loi/iaac20
The content of goals in individual educational programs for students with complex communication needs Nina Klang, Charity Rowland, Melanie Fried-Oken, Sandra Steiner, Mats Granlund & Margareta Adolfsson To cite this article: Nina Klang, Charity Rowland, Melanie Fried-Oken, Sandra Steiner, Mats Granlund & Margareta Adolfsson (2016) The content of goals in individual educational programs for students with complex communication needs, Augmentative and Alternative Communication, 32:1, 41-48, DOI: 10.3109/07434618.2015.1134654 To link to this article: http://dx.doi.org/10.3109/07434618.2015.1134654
Published online: 02 Feb 2016.
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Date: 13 March 2016, At: 23:36
Augmentative and Alternative Communication, 2016 VOL. 32, NO. 1, 41–48 http://dx.doi.org/10.3109/07434618.2015.1134654
RESEARCH ARTICLE
The content of goals in individual educational programs for students with complex communication needs Nina Klanga, Charity Rowlandb, Melanie Fried-Okenb, Sandra Steinerb, Mats Granlundc and Margareta Adolfssonc Department of Education, Uppsala University, Uppsala, Sweden; bInstitute on Development and Disability, Oregon Health and Science University, Portland, OR, USA; cCHILD, Institute of Disability Research, School of Health Sciences, Jo¨nko¨ping University, Jo¨nko¨ping, Sweden
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a
ABSTRACT
ARTICLE HISTORY
The aim of the study was to explore the contents of communication-related goals in individualized education programs (IEPs) for students with complex communication needs. Goals in 43 IEPs were linked to the International Classification of Functioning, Disability and Health, Children and Youth version (ICFCY). The results show that the communication-related IEP goals contain information on multiple domains of functioning in the ICF-CY. However, judging by the amount of codes linked to ICF-CY chapters, the IEPs contain a relatively small proportion of goals that focus on interaction with others, or participation in classroom and leisure activities. Special education teachers and speech-language pathologists working with students with complex communication needs may need support to formulate communicationrelated IEP goals with a focus on interaction and participation in school activities.
Received 30 May 2015 Revised 15 December 2015 Accepted 16 December 2015 Published online 28 January 2016
Introduction Several challenges exist in the provision of opportunities for participation in classroom activities for students with complex communication needs. A study of academic curricula for students with significant disabilities revealed that teachers tended to rely on students’ passive participation in instruction (Karvonen, Wakeman, Browder, Rogers, & Flowers, 2011). Teachers’ expectations of students’ performance in the study were shown to be related to students’ level of communication. Studies in classroom settings show that students with complex communication needs may not actively participate in classroom discussions (Bunning, Smith, Kennedy, & Greenham, 2013; Chung, Carter, & Sisco, 2012), tend to be engaged in fewer activities, and have fewer peer contacts than typically developing children (Raghavendra, Olsson, Sampson, McInerney, & Connell, 2012). The outlined challenges underscore the importance of supporting students’ communication and interaction with peers and teachers. This study aims to explore how professionals working with children with complex communication needs formulate communication-related goals in Individualized Education Programs (IEPs). The IEP is a legal document developed to outline a student’s learning needs; specify goals to address those needs; and list the program, placement, and services that will support the student in attainment of the goals in the least restrictive environment. IEPs are used in many countries to document adaptations in instruction for students with disabilities. Although the requirements for the IEP development process are different, the purpose of IEPs is the same: to document the child’s educational needs and outline a plan for meeting CONTACT Nina Klang
[email protected]
Complex communication needs; individual educational program; ICF-CY; children; intervention goals; participation
those needs. Studies of IEP contents in different national contexts may provide insights into how instructional adaptations for students with complex communication needs are planned and documented. In this study the content of IEPs from 17 states in the United States has been examined in order to achieve insight into how communication-related goals are documented for students with complex communication needs. In the US, an IEP must include: (a) the present level of function and its effect on the student’s progress in the general education curriculum, (b) measurable annual goals with short-term objectives, (c) a description of how and when the student’s progress towards meeting annual goals will be measured, (d) a statement of the special education and related services and accommodations to be provided, (e) the extent, if any, to which the student will not participate in regular classroom activities, (f) a statement of any accommodations for alternative assessment and why the student needs them, and (g) the start date, frequency, location, and duration of services (IDEA, 2004). Previous research on IEPs raised concerns about the IEP development process, as well as the quality of IEP contents (Blackwell & Rossetti, 2014). Studies show that educators have difficulties in documenting children’s functioning and environmental issues. The documented assessments do not always account for the influence of the school environment on students’ performance (Castro, Pinto, & Simeonsson, 2014; Sanches-Ferreira, Lopes-dos-Santos, Alves, Santos, & SilveiraMaia, 2013). The documented interventions may be standardized and fail to take into account the student’s unique needs (Castro et al., 2014; Ruble, McGrew, Dalrymple, & Jung, 2010).
Department of Education, Uppsala University, Box 2136, 750 02 Uppsala, Sweden
ß 2016 International Society for Augmentative and Alternative Communication
KEYWORDS
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N. KLANG ET AL.
Kurth & Mastergeorge (2010) found that IEP goals and interventions for students with autism spectrum disorder tended to focus on core characteristics of children’s diagnoses rather than instructional adaptations. The tendency to focus on diagnostic characteristics was more frequent for children placed in restrictive settings than for children who were included in mainstream education. Because IEP goals are expected to guide interventions, they are the most essential component of the document (Bornman & Murphy, 2006; Poppes, Vlasklamp, de Geeter, & Nakken, 2002). Studies indicate that teachers experience difficulties in formulating measurable and generalizable IEP goals (Giarenco, Dennis, Edelman, & Cloninger, 1994; Sanches-Ferreira et al., 2013). Another challenge, with regard to children with complex communication needs, is to target outcomes related to children’s participation and social interaction (Light & McNaugton (2014)). Adolfsson, Malmqvist, Pless, and Granlund (2011) reported that established single-dimensional norm-referenced measures, used in assessment and intervention, focus on body functions or individual skills. Other measures may be needed to take into account child participation. Giving children the opportunity to speak for themselves contributes an important additional perspective to goal setting (Nilsson et al., 2015); however, children are not always included in the IEP development process. For example, Pawley and Tennant (2008) revealed that students were seldom involved in the IEP development process and had a different understanding of their IEP goals compared to the professionals who developed them.
A Multidimensional Model for Analyzing IEP Goals Several factors need to be accounted for in communication interventions in school settings: assistive technology for communication; the structure of classroom settings; and professionals’ workplace context in terms of professional development, time, and resources (De Bortoli, Arthur-Kelly, Foreman, Balandin, & Mathisen, 2011; De Bortoli, Arthur-Kelly, Mathisen, & Balandin, 2014). Attitudes and expectations of communication partners, as well as the supports they provide to students with complex communication needs, play a unique role in the success of communication interventions (Blackstone,
Williams, & Wilkins, 2007; Light & McNaughton, 2014). In order to analyze whether the communication-related IEP goals reflect the complexity of communication, the current study used the multidimensional model of the International Classification of Functioning, Disability and Health, Children and Youth Version, ICF-CY (World Health Organization [WHO], 2007). The ICF-CY model reflects the ongoing influence of factors at different levels of development in an interactive and hierarchical system. As a classification, the ICF-CY is organized into two parts, with two components in each part with related chapters and categories. The 1685 items are identified by codes providing different levels of detail (WHO, 2007). Part 1, Functioning and Disability, includes the components Body Functions and Body Structures as well as Activities and Participation. While codes in Body Functions describe how a child functions mentally and physiologically, codes in Activities and Participation describe how a child performs tasks and participates in activities in everyday life. Part 2, Contextual Factors, includes Environmental Factors and Personal Factors (the latter is not classified in the ICF-CY). Environmental Factors describe both physical and social environments, as well as services and policies. The ICF-CY codes can be used as a common language to organize and describe children’s functioning and the role of the environment for functioning (Simeonsson, Sauer-Lee, Granlund, & Bjo¨rck-A˚kesson, 2010). The ICF-CY has previously been used in research on augmentative and alternative communication (AAC) (Bornman & Murphy, 2006; McLeod & McCormack, 2007; Raghavendra, Bornman, Granlund, & Bjo¨rck-A˚kesson, 2007; Rowland et al., 2012; Simeonsson, 2003). For children with speech impairment and children with complex communication needs, assessment and intervention must consider a broad range of factors related to child functioning (see Table 1). As seen in Table 1, content in most chapters in the ICF-CY components of Body Functions, Body Structures, Activities and Participation, and Environmental Factors is applicable to assessment and intervention, with a focus on communication. With regard to documentation of support to children with complex communication needs in IEPs, there is a need to investigate whether this broad range of factors is reflected in IEP goals and objectives.
Table 1. ICF-CY Codes on Chapter Level, Suggested as Important in Assessment and Intervention for Students with Complex Communication Needs. Body functions b1 Mental functionsa,
Body structures b, c, d
b2 Sensory functions and paina,
b, c, d
a, b, c, d
b3 Voice and speech functions
b4 Functions of cardiovascular, haematological, immunological, and respiratory systemsd b7 Neuromusculoskeletal and movement-related functionsc, d
a
Simeonsson (2003), McLeod and McCormack (2007), c Raghavendra et al. (2007), d Rowland et al. (2012) b
s1 Structures of the nervous systema, c s2 The eye, ear, and related structuresa, c s3 Structures involved in voice and speechc s430 Structures of respiratory systemc
Activities and participation
Environmental factors
d1 Learning and applying knowledgec, d2 General tasks and demandsd
d
e1 Products and technologya,
b, c, d
d3 Communication
e2 Natural environment and human-made changes to environmenta, d e3 Support and relationshipsb, c, d
d4 Mobilityd
e4 Attitudesc,
d5 Self-cared d6 Domestic lifec, d d7 Interpersonal interactions and relationshipsc, d d8 Major life areasc, d d9 Community, social, and civic lifec,
e5 Services, systems, and policiesc,
a, b, c, d
d
d d
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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION
The constructs of Activity and Participation are of particular importance in assessment and intervention for students with complex communication needs. Simeonsson (2003) has suggested a paradigm shift in rehabilitation and special education, from a focus on training skills to promoting participation in society. With regard to children’s communicative competence, it is important that interventions focus on not only the development of isolated skills but also the use of skills in communication and interaction with others (Blackstone et al., 2007; Calculator, 1999; Granlund, 2013; Light & Drager, 2007; Light & McNaughton, 2014; Pless & Granlund, 2012). The ICF-CY defines activity as ‘‘The execution of a task or action by an individual’’ (WHO, 2007, p. 9). It reflects an individual perspective that does not necessarily include consideration of the influence of the environment. Participation, on the other hand, reflects a societal perspective and is defined as ‘‘involvement in a life situation’’ (WHO, 2007, p. 9). The two constructs are not linked to specific chapters (domains) within the ICF-CY, which has given rise to debates among researchers regarding the designation of chapters as Activity- or Participation-based (Badley, 2008; Coster & Khetani, 2008; McConachie, Colver, Forsyth, Jarvis, & Parkinson, 2006; Whiteneck & Dijkers, 2009). The ICF-CY in Annex 3 (WHO, 2007, p. 248) provides four alternative options for structuring the relationships between Activities and Participation in terms of the following chapter list: (a) distinct sets of Activities domains and Participation domains, (b) partial overlap between sets of Activities and Participation domains, (c) detailed categories as Activities and broad categories as Participation, with or without overlap, and (d) use of the same domains for both Activities and Participation with total overlap of domains. Theoretically, the ICF-CY definition of Participation as involvement in a life situation is easier to apply to Options 1 and 2. This definition primarily seems appropriate to apply to complex tasks related to role performance, performed intentionally in a specified context. The probability that a category has these characteristics is higher for ICF-CY Chapters 7 to 9 (Whiteneck & Dijkers, 2009). Badley (2008) argues that key characteristics of Participation are role performance and interaction with others. However, emphasis on these characteristics excludes participation in activities that are meaningful and goal directed without involving others. This study is focused on IEP goals involving communication and interaction with others as a prerequisite. Therefore, the assignment of Activity or Participation codes was guided by Whiteneck and Dijkers (2009), viewing the first six chapters as Activity, because these describe individual actions not necessarily involving others; and the last three chapters as Participation, because these involve actions with others and societal roles. Using the constructs of Activity and Participation when linking IEP goals to ICF-CY codes makes it possible to explore whether the IEP goals contain an individual or societal focus. The aim of this study was to explore how the contents of communication-related IEP goals are distributed according to the ICF-CY model. An additional aim was to explore whether the contents of the communication-related IEP goals for children with complex communication needs mirror the paradigm shift from the individual level to focusing on the
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societal level of functioning, as operationalized through codes in the components and chapters of the ICF-CY. The following research questions were investigated: (a) How many ICF-CY codes are assigned to communication-related IEP goals at the component level? (b) How many ICF-CY codes are assigned to communication-related IEP goals at the chapter level? (c) How many ICF-CY codes in Activity and Participation are assigned to communication-related IEP goals?
Method Participants A total of 43 IEPs of students with complex communication needs were collected as part of the data collection process for development of the Communication Supports InventoryChildren & Youth (CSI-CY; Rowland et al., 2012). Recruitment efforts targeted educators and school-based speech-language pathologists who were responsible for writing communicationrelated IEP goals for currently served students with complex communication needs in grades K-12. All recruitment took place in the US. Announcements outlining the aim of collecting information on communication-related educational goals of children who used, or potentially could benefit from AAC, were posted to professional listservs and at various professional conferences. Participants were offered a gift card in the amount of $100.00 as compensation for providing the data. All study tasks were approved by the Institutional Review Board of the Oregon Health & Science University. As seen in Table 2, 43 special education teachers and speech-language pathologists from 17 states participated in the study. The participants reported considerable experience of work with children with complex communication needs, moderate knowledge levels of AAC, and limited knowledge of the ICF-CY. No information was provided about whether
Table 2. Background Information About Professionals (N ¼ 43).
Profession Special education teachers Speech-language pathologists Other Work setting Special day school Elementary school Secondary school Combined school settings Other Experience of children with complex communication needs 1-5 years 6-10 years 11-20 years 21 years or more Length of time working with the child 1 to 6 months 1 year or more Unknown AAC knowledge No or little knowledge Moderate knowledge Extensive or expert knowledge ICF knowledge No or little knowledge Moderate knowledge
n
%
17 24 2
39.5 55.8 4.7
5 12 10 15 1
11.6 27.9 23.3 34.9 2.3
10 14 5 14
23.2 32.6 11.6 32.6
10 22 11
23.2 51.2 25.6
3 25 15
6.9 58.1 35.0
41 2
95.3 4.7
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N. KLANG ET AL.
speech-language pathologists worked according to pullout or classroom-based models of service delivery. However, most of the participants were well acquainted with the children and reported that they had been working with the targeted child for more than 1 year. The targeted students were between 5 and 20 years old (M ¼ 12) and were enrolled in elementary school, middle school, or secondary school (see Table 3). The most frequently identified disability categories for the targeted students were autism spectrum disorder, cerebral palsy, and intellectual disability.
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Material The communication-rated goals included both annual goals and related short-term objectives. In total, the IEPs contained 428 annual goals and short-term objectives related to communication. The number of goals and objectives per IEP varied from one to nine goals (M ¼ 3) and one to 18 short-term objectives (M ¼ 7).
Table 3. Background Information About Students (N ¼ 43).
Age 3-5 6-9 10-12 13-18 19-21 Gender Female Male Grade level of targeted student Elementary school (Grades 1 to 6) Middle school (Grade 7 to 8) Secondary school (Grade 9 to 12) Reported disability categories ASD Cerebral palsy Intellectual disability Other
n
%
2 11 7 21 2
4.7 25.6 16.2 48.8 4.7
13 30
30.2 69.8
16 12 15
37.2 27.9 34.9
13 9 8 13
30.2 20.9 18.7 30.2
Data Analysis Linking rules were used together with rules of content analysis to divide the texts of IEP goals into meaning units, extract meaningful concepts, and assign ICF-CY codes to the extracted concepts (Cieza et al., 2005; Graneheim Ha¨llgren & Lundman, 2004). According to linking rules (Cieza et al., 2005), meaningful concepts must be extracted from texts before assigning ICF-CY codes. Meaning units were defined as words, sentences, or paragraphs containing aspects related to each other through their content. Every goal and every objective was considered as a separate meaning unit. Within every goal and objective, meaningful concepts were extracted, in accordance with ICF linking rules (Cieza et al., 2005). Four types of meaningful concepts (MC) were discerned. These are displayed in Table 4 together with examples. In the ICF-CY, an alphanumeric system is used, in which letters and numbers denote different levels in the hierarchy of the classification. The letters b, s, d, and e are used for the components Body Functions, Body Structures, Activities and Participation, and Environmental Factors. The letters are followed by a numeric code to denote chapter number (first level), followed by the codes on the second, third, and fourth levels. The meaningful concepts were linked to the most precise ICF-CY code on the first, second, third, or fourth levels. In addition, in accordance with linking rules (Cieza et al., 2005), categories Not Definable, and Not Covered were assigned to the meaningful concepts, if the concepts could not be linked to the most precise ICF-CY code or were not covered in a classification. In this study, the division between Activities and Participation was made in accordance with one of the options of the ICF-CY: viewing the first six chapters as Activity and the three last chapters as Participation (Whiteneck & Dijkers, 2009; WHO, 2007). Thus, a distinction was made between goals that focus on the decontextualized use of skills in communication and the use of communication skills to participate in interaction with others, in school activities, and in leisure activities. Inter-rater reliability was checked three times. Initially, it was conducted for 10% of the material (43 goals). Based on the
Table 4. Example of Linking IEP Goals and Short-term Objectives to the ICF-CY Codes.
Type of meaningful concept
MC1 Support provided for the task
MC2 Communicative mode/AAC
Given descriptive text and two images,
By directing action and/or commenting on activity 2x per session 4 out of 5 charted trials d3500, d3501 [Student] will demonstrate knowledge of vocabulary
Example (goal 23) ICF-CY code Example (goal 29) ICF-CY code Example (goal 267) ICF-CY code Example (goal 189) ICF-CY code Example (goal 350)
ICF-CY code
e1300 During structured tasks with prompts e1301 As directed by her learning partner e3
d133 [Student] will use his SGD d360 Will navigate his SGD d360 Will maintain communication skills
d3500
MC3 Purpose of communication
MC4 Broader context for the task [Student] will engage in cooperative play with a peer d7504
By matching the text to the correct image with 85% accuracy. d1402 Commenting or answering questions d3501 To find pages, words, phrases and sentences Not Definable To participate and respond to social interaction activities with a given communication partner d750
Participate in group learning activities d8201
As seen in Figure 1, the IEP goals were primarily focused on the component of Activities and Participation, followed by Environmental factors. Few goals focused on the component of Body functions. The category Not Definable was assigned to six meaningful concepts in the texts of goals and objectives, indicating that few meaningful concepts were difficult to assign to a precise ICF-CY code. None of the IEP goals were assigned the categories Not Covered or Personal Factors.
ICF-CY Codes Assigned at the Chapter Level In Figure 2, the results of linking at the chapter level are presented. In Body Functions, Chapter 1, Mental Functions (e.g., developing awareness of one’s own mouth structure) and Chapter 3, Voice and Speech Functions (e.g., articulating), are targeted in the goals. In Activities and Participation, all
500
469
450
Number of codes
400 350 300 250 200
154
150 100 50
22
0 Body Structures
Body Functions
Activities and Participation
Environmental Factors
ICF-CY components Figure 1. The number of ICF-CY codes assigned to IEP goals and objectives at component level.
250 197
200
145
150
126
100
76
50 10
1
11
19
45
Results ICF-CY Codes Assigned at Component Level
discussion of initial inter-rater reliability, additional rules, and a coding scheme were elaborated. The coding rules concerned how to extract four specific types of meaningful concepts in texts of IEP goals before assigning an appropriate ICF-CY code (see Table 4). The coding scheme contained examples of meaningful concepts and assigned ICF-CY codes. When the first author completed the linking process, the sixth author linked 25% of the material (107 goals and objectives). Interrater reliability, calculated by dividing the number of agreements for meaningful concepts by the total number of meaningful concepts, was 62% on the most detailed levels (third and fourth levels). Analysis of disagreements showed systematic patterns of disagreement, for example, where writing was viewed as communication (d3) by one researcher and learning by the other (d1). The patterns were discussed and, based on the results of the discussions, the coding of IEP goals containing that kind of meaningful concepts was revised. Inter-rater reliability after discussions was 92% on the third level and 66% on the fourth level.
Number of codes
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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION
28 2
2
6
13
8
0
ICF-CY chapters Figure 2. The number of ICF-CY codes assigned to IEP goals and objectives at chapter level.
1
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N. KLANG ET AL.
chapters are focused in the goals. However, the majority of ICF-CY codes were assigned in Chapter 1, Learning and Applying Knowledge; Chapter 3, Communication; Chapter 7, Interpersonal Interactions and Relationships; and Chapter 8, Major Life Areas. In Environmental Factors, only codes from three of five chapters were used: Chapter 1, Products and Technology, containing codes on assistive technology as well as materials and methods of teaching, were assigned most codes, followed by Chapter 3, Personal Support; and Chapter 5, Systems, Services, and Policies. Few goals were linked to Chapter 3, Personal Support, which indicates that social support from teachers and peers is sparsely documented in the communication-related IEP goals.
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ICF-CY Codes Assigned per Activity and Participation Applying the distinction between Activities and Participation, the first six chapters are viewed as Activity and the three remaining chapters are viewed as Participation. Summarizing the number of codes per chapter according to this division resulted in 352 codes in Activity and 117 codes in Participation. Thus, the results indicate that relatively few goals focus on broader outcomes in terms of interaction, participation in school, and leisure activities.
Discussion The aim of the study was to explore how the contents of communication-related IEP goals for children with complex communication needs are distributed according to the multidimensional model of the ICF-CY. An additional goal was to explore whether the contents of the communication-related IEP goals mirror the paradigm shift from focusing on the individual level of functioning to the societal level, as analyzed through the constructs of activity and participation in the ICFCY. The results show that IEP goals focus on ICF-CY components Activities and Participation and Environmental Factors as well as Body Functions. It can be concluded that the IEP goals in US schools reflect the broad range of ICF-CY codes that have been suggested in the assessment of communication in previous research (Bornman & Murphy, 2006; McLeod & Threats, 2008; Raghavendra et al., 2007; Rowland et al., 2012; Simeonsson, 2003). The results also reveal that IEP goals focusing on Activity are more frequent than goals focusing on Participation. The IEP goals tend to focus on individual acts by the children such as learning and communicating through different modes, but to a lesser extent on interacting with others and participating in classroom-related and leisure activities. The fact that the number of codes denoting Participation constitutes approximately one-third of the total number of codes in the component Activities and Participation indicates that a shift toward participation goals is not fully realized.
Environmental Factors in the IEP Goals It is important that Environmental Factors are documented in IEPs because several factors in classroom and school environments can influence children’s participation
(De Bortoli et al., 2011; De Bortoli et al., 2014). However, previous analyses of IEPs for children with disabilities reported that IEPs contain a small amount of information concerning environmental factors (Castro et al., 2014; Sanches-Ferreira et al., 2013). In this study, a considerable number of codes were assigned to the ICF-CY component, Environmental Factors. More detailed analysis at the chapter level reveals that codes in Chapter 1, Products and Technology, concerning assistive technology and materials and methods of teaching, were most frequently used. Fewer codes were assigned to Chapter 3, Personal Support, concerning support from teachers and peers. Studies have shown that students with complex communication needs need support to be able to actively participate in classroom activities (Bunning et al., 2013; Chung et al., 2012; Raghavendra et al., 2012). The importance of communication partners has been emphasized as a prerequisite for success in interventions (Blackstone et al., 2007; Light & McNaughton, 2014). It may be important to further investigate how social and emotional support and attitudes of teachers and peers can be documented in IEPs.
Activity and Participation in the IEP Goals In the field of AAC, the importance of broader outcomes with a focus on participation and use of communication skills in interaction with others is emphasized (Blackstone et al., 2007; Calculator, 1999; Light & Drager, 2007; Light & McNaughton, 2014; Pless & Granlund, 2012). The secondary aim of this study was to explore whether the paradigm shift calling for a focus on societal aspects of students’ participation is mirrored in the communication-related IEP goals. This was studied with the help of the constructs Activity and Participation in the ICF-CY, the former focusing on the individual perspective and the latter on the societal perspective. The results of the study show that the number of codes in Participation only accounts for one-third of the codes assigned to the Activity and Participation component. The results can be partly explained by the uneven distribution of the codes in the ICF-CY classification, with six chapters aligned to Activity and three chapters to Participation dimensions. Viewed at chapter level, the IEP goals focus on learning (Chapter 1, Learning and Applying Knowledge) and communication skills (Chapter 3, Communication) to a greater extent than on using communication skills in actual interaction with others (Chapter 7, Interpersonal Interactions and Relationships) or participating in school and leisure activities (Chapter 8, Major Life Areas). It is encouraging that the IEP goals focus on children’s functioning in everyday school environment, especially on language acquisition and communication skills, as these are prerequisites for students’ participation (Granlund, 2013). However, there seems to be a need to support professionals in formulating broad goals with a focus on children’s participation and addressing the use of communication skills in interaction with others and in school activities. Participation-focused goals concern a child’s social involvement and presuppose his or her direct involvement in goal setting. In this study it is not known to what degree the children were active in the IEP development process. Although the adults may consider the child’s
AUGMENTATIVE AND ALTERNATIVE COMMUNICATION
perspective and his or her best interests, they cannot actually take the child’s own perspective (Nilsson et al., 2015). Giving voice to the perspective of children themselves will most likely enhance children’s motivation to engage actively in important interventions.
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Limitations The results of the study must be treated with caution due to the limited number of IEP goals included in the analysis. The examined IEPs are related to the context of only one country, the US, and thus must be interpreted in that context. However, examination of the IEP goals may have implications for IEPs developed in other countries. The goals and short-term objectives were nested within IEPs, thus resulting in limited variation in the goals and objectives. Furthermore, the conclusions from the study are based on professionals’ documentation of IEP goals. The study did not consider other components of the IEPs outside of the educational goals and objectives, such as the methods chosen to implement IEPs or how selected goals were related to individual child characteristics. A more detailed analysis that includes interviews with professionals and examining other IEP components may be needed to achieve a better understanding of the focus of communication interventions in educational contexts. In this study, there was no information about the level of inclusion of the targeted students in educational settings. Previous studies reveal that formulation of IEP goals may be different, depending on whether or not students are placed in inclusive settings (Kurth & Mastergeorge, 2011 therefore, there may be a need for data on the degree of a student’s educational inclusion, in order to provide insights into background factors related to goal-setting.
Conclusion This study was informed by the need to investigate the content of communication-related goals developed for students with complex communication needs. The results indicate that, while the IEP goals contain information related to several components of the ICF-CY, few goals are formulated in terms of participation. Although the division between Activity and Participation used in this study may have influenced the results, the fact that IEP goals contain a relatively small amount of information on interaction with others and participation in school and leisure activities is noteworthy. This suggests an individual focus in terms of intervention outcomes rather than a societal focus, which would include the child’s participation in activities that are meaningful and that involve interaction with other people. Given the participation challenges faced by students with complex communication needs in classroom activities, it is important that communication-related IEP goals explicitly target participation outcomes. Additionally, the provision of social and emotional support by professionals was addressed infrequently in IEPs. This could be an enhanced focus for discussion in future IEPs.
Disclosure statement The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.
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References Adolfsson, M., Malmqvist, J., Pless, M., & Granlund, M. (2011). Identifying child functioning from an ICF-CY perspective: Everyday life situations explored in measures of participation. Disability and Rehabilitation, 33, 1230–1244. Badley, E. (2008). Enhancing the conceptual clarity of the activity and participation components of the International Classification of Functioning, Disability, and Health. Social Science and Medicine, 66, 2335–2345. Blackstone, S.W., Williams, M.B., & Wilkins, D.P. (2007). Key principles underlying research and practice in AAC. Augmentative and Alternative Communication, 23, 191–203. Blackwell, W.H., & Rossetti, Z.S. (2014). The development of individualized education programs: where have we been and where should we go? SAGE Open, 4. doi:10.1177/2158244014530411 Bornman, J., & Murphy, J. (2006). Using the ICF in goal setting: Clinical application using Talking Mats. Disability and Rehabilitation: Assistive Technology, 1, 145–154. Bunning, K., Smith, C., Kennedy, P., & Greenham, C. (2013). Examination of the communication interface between students with severe to profound and multiple intellectual disability and educational staff during structured teaching sessions. Journal of Intellectual Disability Research, 57, 39–52. Calculator, S.N. (1999). AAC outcomes for children and youth with severe disabilities: When seeing is believing. Augmentative and Alternative Communication, 15, 4–12. Castro, S., Pinto, A., & Simeonsson, R.J. (2014). Content analysis of Portuguese individualized education programmes for young children with autism using the ICF-CY framework. European Early Childhood Education Research Journal, 22, 91–104. Chung, Y.-C., Carter, E.W., & Sisco, L.G. (2012). Social interactions of students with disabilities who use augmentative and alternative communication in inclusive classrooms. American Journal of Intellectual and Developmental Disabilities, 117, 349–367. Cieza, A., Geyh, S., Chatterji, S., Kostanjsek, N., U¨stu¨n, T. B., & Stucki, G. (2005). ICF linking rules: An update based on lessons learned. Journal of Rehabilitation Medicine, 37, 212–218. Coster, W., & Khetani, M.A. (2008). Measuring participation of children with disabilities: Issues and challenges. Disability and Rehabilitation, 30, 639– 648. De Bortoli, T., Arthur-Kelly, M., Foreman, P., Balandin, S., & Mathisen, B., (2011). Complex contextual influences on the communicative interactions of students with multiple and severe disabilities. International Journal of Speech-Language Pathology, 13, 422–435. De Bortoli, T., Arthur-Kelly, M., Mathisen, B., & Balandin, S. (2014). Speechlanguage pathologists’ perceptions of implementing communication intervention with students with multiple and severe disabilities. Augmentative and Alternative Communication, 30, 55–70. Giarenco, M.F., Dennis, R.E., Edelman, S.W., & Cloninger, C.J. (1994). Dressing your IEPs for the general education climate. Analysis of IEP goals and objectives for students with multiple disabilities. Remedial and Special Education, 15, 288–296. Graneheim Ha¨llgren, U., & Lundman, B. (2004). Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24, 105–112. Granlund, M. (2013). Participation – Challenges in conceptualization, measurement and intervention. Child: Care, Health and Development, 39, 470–473. IDEA (2004). Individuals with Disabilities Educational Act. Retrieved from www.idea.ed.gov Karvonen, M., Wakeman, S.Y., Browder, D.M., Rogers, M.A.S., & Flowers, C. (2011). Academic curriculum for students with significant cognitive disabilities: Special education teacher perspectives a decade after IDEA 1997. Retrieved from ERIC database (ED521407). Kurth, J., & Mastergeorge, A.M. (2010). Individual education plan goals and services for adolescents with autism: Impact of age and educational setting. The Journal of Special Education, 44, 146–160. Light, J., & Drager, K. (2007). AAC technologies for young children with complex communication needs: State of the science and future research directions. Augmentative and Alternative Communication, 23, 204–216.
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Light, J., & McNaughton, D. (2014). Communicative competence for individuals who require augmentative and alternative communication: A new definition for a new era of communication? Augmentative and Alternative Communication, 30, 1–18. McConachie, H., Colver, A.F., Forsyth, R.J., Jarvis, S.N., & Parkinson, K.N. (2006). Participation of disabled children: How should it be characterized and measured? Disability and Rehabilitation, 28, 1157–1164. McLeod, S., & McCormack, J. (2007). Application of the ICF and ICF-Children and Youth in children with speech impairment. Seminars in Speech and Language, 28, 254–264. McLeod, S., & Threats, T.T. (2008). The ICF-CY and children with communication disabilities. International Journal of Speech-Language Pathology, 10, 92–1009. Nilsson, S., Bjo¨rkman, B., Almqvist, A.-L., Almqvist, L., Bjo¨rk-Wille´n, P., Donohue, D., . . . & Hvit, S. (2015). Children’s voices: Differentiating a child perspective from a child’s perspective. Developmental Neurorehabilitation, 18, 162–168. Pawley, H., & Tennant, G. (2008). Student perceptions of their IEP targets. Support for Learning, 23, 183–186. Pless, M., & Granlund, M. (2012). Implementation of the International Classification of Functioning, Disability and Health (ICF) and the ICF Children and Youth version (ICF-CY) within the context of augmentative and alternative communication. Augmentative and Alternative Communication, 28, 11–20. Poppes, P., Vlasklamp, C., de Geeter, K.I., & Nakken, H. (2002). The importance of setting goals: The effect of instruction and training on the technical and intrinsic quality of goals. European Journal of Special Needs Education, 17, 241–250. ˚ kesson, E. (2007). The Raghavendra, P., Bornman, J., Granlund, M., & Bjo¨rck-A World Health Organization’s International Classification of Functioning, Disability and Health: Implications for clinical and research practice in
the field of augmentative and alternative communication. Augmentative and Alternative Communication, 23, 349–361. Raghavendra, P., Olsson, C., Sampson, J., McInerney, R., & Connell, T. (2012). School participation and social networks of children with complex communication needs, physical disabilities and typically developing peers. Augmentative and Alternative Communication, 28, 33–43. Rowland, C., Fried-Oken, M., Steiner, S.A.M., Lollar, D., Phelps, R., Simeonsson, R.J., & Granlund, M. (2012). Developing the ICF-CY for AAC profile and code set for children who rely on AAC. Augmentative and Alternative Communication, 28, 21–32. Ruble, L.A., McGrew, J., Dalrymple, N., & Jung, L.A. (2010). Examining the quality of IEPs for young children with autism. Journal of Autism and Developmental Disorders, 40, 1459–1470. Sanches-Ferreira, M., Lopes-dos-Santos, P., Alves, S., Santos, M., & SilveiraMaia, M. (2013). How individualised are the individualised education programmes (IEPs): An analysis of the contents and quality of the IEPs goals. European Journal of Special Needs Education, 28, 507–520. Simeonsson, R.J. (2003). Classification of communication disabilities in children: Contribution of the International Classification on Functioning, Disability and Health. International Journal of Audiology, 42, S2–S8. ˚ kesson, E. (2010). Simeonsson, R.J., Sauer-Lee, A., Granlund, M., & Bjo¨rck-A Developmental and health assessment in rehabilitation with the ICF for children and youth. In E. Mpofu & T. Oakland (Eds.), Rehabilitation and health assessment: Applying ICF guidelines (pp. 27–46). New York: Springer publishing company. Whiteneck, G., & Dijkers, M.P. (2009). Difficult to measure constructs: Conceptual and methodological issues concerning participation and environmental factors. Arch Phys Medical Rehabilitation, 90, S22–S35. WHO (2007). International Classification of Functioning, Disability, and Health, Children and Youth version. Geneva: World Health Organization.
ISSN: 0743-4618 (Print) 1477-3848 (Online) Journal homepage: http://www.tandfonline.com/loi/iaac20
The content of goals in individual educational programs for students with complex communication needs Nina Klang, Charity Rowland, Melanie Fried-Oken, Sandra Steiner, Mats Granlund & Margareta Adolfsson To cite this article: Nina Klang, Charity Rowland, Melanie Fried-Oken, Sandra Steiner, Mats Granlund & Margareta Adolfsson (2016) The content of goals in individual educational programs for students with complex communication needs, Augmentative and Alternative Communication, 32:1, 41-48, DOI: 10.3109/07434618.2015.1134654 To link to this article: http://dx.doi.org/10.3109/07434618.2015.1134654
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Augmentative and Alternative Communication, 2016 VOL. 32, NO. 1, 41–48 http://dx.doi.org/10.3109/07434618.2015.1134654
RESEARCH ARTICLE
The content of goals in individual educational programs for students with complex communication needs Nina Klanga, Charity Rowlandb, Melanie Fried-Okenb, Sandra Steinerb, Mats Granlundc and Margareta Adolfssonc Department of Education, Uppsala University, Uppsala, Sweden; bInstitute on Development and Disability, Oregon Health and Science University, Portland, OR, USA; cCHILD, Institute of Disability Research, School of Health Sciences, Jo¨nko¨ping University, Jo¨nko¨ping, Sweden
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a
ABSTRACT
ARTICLE HISTORY
The aim of the study was to explore the contents of communication-related goals in individualized education programs (IEPs) for students with complex communication needs. Goals in 43 IEPs were linked to the International Classification of Functioning, Disability and Health, Children and Youth version (ICFCY). The results show that the communication-related IEP goals contain information on multiple domains of functioning in the ICF-CY. However, judging by the amount of codes linked to ICF-CY chapters, the IEPs contain a relatively small proportion of goals that focus on interaction with others, or participation in classroom and leisure activities. Special education teachers and speech-language pathologists working with students with complex communication needs may need support to formulate communicationrelated IEP goals with a focus on interaction and participation in school activities.
Received 30 May 2015 Revised 15 December 2015 Accepted 16 December 2015 Published online 28 January 2016
Introduction Several challenges exist in the provision of opportunities for participation in classroom activities for students with complex communication needs. A study of academic curricula for students with significant disabilities revealed that teachers tended to rely on students’ passive participation in instruction (Karvonen, Wakeman, Browder, Rogers, & Flowers, 2011). Teachers’ expectations of students’ performance in the study were shown to be related to students’ level of communication. Studies in classroom settings show that students with complex communication needs may not actively participate in classroom discussions (Bunning, Smith, Kennedy, & Greenham, 2013; Chung, Carter, & Sisco, 2012), tend to be engaged in fewer activities, and have fewer peer contacts than typically developing children (Raghavendra, Olsson, Sampson, McInerney, & Connell, 2012). The outlined challenges underscore the importance of supporting students’ communication and interaction with peers and teachers. This study aims to explore how professionals working with children with complex communication needs formulate communication-related goals in Individualized Education Programs (IEPs). The IEP is a legal document developed to outline a student’s learning needs; specify goals to address those needs; and list the program, placement, and services that will support the student in attainment of the goals in the least restrictive environment. IEPs are used in many countries to document adaptations in instruction for students with disabilities. Although the requirements for the IEP development process are different, the purpose of IEPs is the same: to document the child’s educational needs and outline a plan for meeting CONTACT Nina Klang
[email protected]
Complex communication needs; individual educational program; ICF-CY; children; intervention goals; participation
those needs. Studies of IEP contents in different national contexts may provide insights into how instructional adaptations for students with complex communication needs are planned and documented. In this study the content of IEPs from 17 states in the United States has been examined in order to achieve insight into how communication-related goals are documented for students with complex communication needs. In the US, an IEP must include: (a) the present level of function and its effect on the student’s progress in the general education curriculum, (b) measurable annual goals with short-term objectives, (c) a description of how and when the student’s progress towards meeting annual goals will be measured, (d) a statement of the special education and related services and accommodations to be provided, (e) the extent, if any, to which the student will not participate in regular classroom activities, (f) a statement of any accommodations for alternative assessment and why the student needs them, and (g) the start date, frequency, location, and duration of services (IDEA, 2004). Previous research on IEPs raised concerns about the IEP development process, as well as the quality of IEP contents (Blackwell & Rossetti, 2014). Studies show that educators have difficulties in documenting children’s functioning and environmental issues. The documented assessments do not always account for the influence of the school environment on students’ performance (Castro, Pinto, & Simeonsson, 2014; Sanches-Ferreira, Lopes-dos-Santos, Alves, Santos, & SilveiraMaia, 2013). The documented interventions may be standardized and fail to take into account the student’s unique needs (Castro et al., 2014; Ruble, McGrew, Dalrymple, & Jung, 2010).
Department of Education, Uppsala University, Box 2136, 750 02 Uppsala, Sweden
ß 2016 International Society for Augmentative and Alternative Communication
KEYWORDS
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Kurth & Mastergeorge (2010) found that IEP goals and interventions for students with autism spectrum disorder tended to focus on core characteristics of children’s diagnoses rather than instructional adaptations. The tendency to focus on diagnostic characteristics was more frequent for children placed in restrictive settings than for children who were included in mainstream education. Because IEP goals are expected to guide interventions, they are the most essential component of the document (Bornman & Murphy, 2006; Poppes, Vlasklamp, de Geeter, & Nakken, 2002). Studies indicate that teachers experience difficulties in formulating measurable and generalizable IEP goals (Giarenco, Dennis, Edelman, & Cloninger, 1994; Sanches-Ferreira et al., 2013). Another challenge, with regard to children with complex communication needs, is to target outcomes related to children’s participation and social interaction (Light & McNaugton (2014)). Adolfsson, Malmqvist, Pless, and Granlund (2011) reported that established single-dimensional norm-referenced measures, used in assessment and intervention, focus on body functions or individual skills. Other measures may be needed to take into account child participation. Giving children the opportunity to speak for themselves contributes an important additional perspective to goal setting (Nilsson et al., 2015); however, children are not always included in the IEP development process. For example, Pawley and Tennant (2008) revealed that students were seldom involved in the IEP development process and had a different understanding of their IEP goals compared to the professionals who developed them.
A Multidimensional Model for Analyzing IEP Goals Several factors need to be accounted for in communication interventions in school settings: assistive technology for communication; the structure of classroom settings; and professionals’ workplace context in terms of professional development, time, and resources (De Bortoli, Arthur-Kelly, Foreman, Balandin, & Mathisen, 2011; De Bortoli, Arthur-Kelly, Mathisen, & Balandin, 2014). Attitudes and expectations of communication partners, as well as the supports they provide to students with complex communication needs, play a unique role in the success of communication interventions (Blackstone,
Williams, & Wilkins, 2007; Light & McNaughton, 2014). In order to analyze whether the communication-related IEP goals reflect the complexity of communication, the current study used the multidimensional model of the International Classification of Functioning, Disability and Health, Children and Youth Version, ICF-CY (World Health Organization [WHO], 2007). The ICF-CY model reflects the ongoing influence of factors at different levels of development in an interactive and hierarchical system. As a classification, the ICF-CY is organized into two parts, with two components in each part with related chapters and categories. The 1685 items are identified by codes providing different levels of detail (WHO, 2007). Part 1, Functioning and Disability, includes the components Body Functions and Body Structures as well as Activities and Participation. While codes in Body Functions describe how a child functions mentally and physiologically, codes in Activities and Participation describe how a child performs tasks and participates in activities in everyday life. Part 2, Contextual Factors, includes Environmental Factors and Personal Factors (the latter is not classified in the ICF-CY). Environmental Factors describe both physical and social environments, as well as services and policies. The ICF-CY codes can be used as a common language to organize and describe children’s functioning and the role of the environment for functioning (Simeonsson, Sauer-Lee, Granlund, & Bjo¨rck-A˚kesson, 2010). The ICF-CY has previously been used in research on augmentative and alternative communication (AAC) (Bornman & Murphy, 2006; McLeod & McCormack, 2007; Raghavendra, Bornman, Granlund, & Bjo¨rck-A˚kesson, 2007; Rowland et al., 2012; Simeonsson, 2003). For children with speech impairment and children with complex communication needs, assessment and intervention must consider a broad range of factors related to child functioning (see Table 1). As seen in Table 1, content in most chapters in the ICF-CY components of Body Functions, Body Structures, Activities and Participation, and Environmental Factors is applicable to assessment and intervention, with a focus on communication. With regard to documentation of support to children with complex communication needs in IEPs, there is a need to investigate whether this broad range of factors is reflected in IEP goals and objectives.
Table 1. ICF-CY Codes on Chapter Level, Suggested as Important in Assessment and Intervention for Students with Complex Communication Needs. Body functions b1 Mental functionsa,
Body structures b, c, d
b2 Sensory functions and paina,
b, c, d
a, b, c, d
b3 Voice and speech functions
b4 Functions of cardiovascular, haematological, immunological, and respiratory systemsd b7 Neuromusculoskeletal and movement-related functionsc, d
a
Simeonsson (2003), McLeod and McCormack (2007), c Raghavendra et al. (2007), d Rowland et al. (2012) b
s1 Structures of the nervous systema, c s2 The eye, ear, and related structuresa, c s3 Structures involved in voice and speechc s430 Structures of respiratory systemc
Activities and participation
Environmental factors
d1 Learning and applying knowledgec, d2 General tasks and demandsd
d
e1 Products and technologya,
b, c, d
d3 Communication
e2 Natural environment and human-made changes to environmenta, d e3 Support and relationshipsb, c, d
d4 Mobilityd
e4 Attitudesc,
d5 Self-cared d6 Domestic lifec, d d7 Interpersonal interactions and relationshipsc, d d8 Major life areasc, d d9 Community, social, and civic lifec,
e5 Services, systems, and policiesc,
a, b, c, d
d
d d
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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION
The constructs of Activity and Participation are of particular importance in assessment and intervention for students with complex communication needs. Simeonsson (2003) has suggested a paradigm shift in rehabilitation and special education, from a focus on training skills to promoting participation in society. With regard to children’s communicative competence, it is important that interventions focus on not only the development of isolated skills but also the use of skills in communication and interaction with others (Blackstone et al., 2007; Calculator, 1999; Granlund, 2013; Light & Drager, 2007; Light & McNaughton, 2014; Pless & Granlund, 2012). The ICF-CY defines activity as ‘‘The execution of a task or action by an individual’’ (WHO, 2007, p. 9). It reflects an individual perspective that does not necessarily include consideration of the influence of the environment. Participation, on the other hand, reflects a societal perspective and is defined as ‘‘involvement in a life situation’’ (WHO, 2007, p. 9). The two constructs are not linked to specific chapters (domains) within the ICF-CY, which has given rise to debates among researchers regarding the designation of chapters as Activity- or Participation-based (Badley, 2008; Coster & Khetani, 2008; McConachie, Colver, Forsyth, Jarvis, & Parkinson, 2006; Whiteneck & Dijkers, 2009). The ICF-CY in Annex 3 (WHO, 2007, p. 248) provides four alternative options for structuring the relationships between Activities and Participation in terms of the following chapter list: (a) distinct sets of Activities domains and Participation domains, (b) partial overlap between sets of Activities and Participation domains, (c) detailed categories as Activities and broad categories as Participation, with or without overlap, and (d) use of the same domains for both Activities and Participation with total overlap of domains. Theoretically, the ICF-CY definition of Participation as involvement in a life situation is easier to apply to Options 1 and 2. This definition primarily seems appropriate to apply to complex tasks related to role performance, performed intentionally in a specified context. The probability that a category has these characteristics is higher for ICF-CY Chapters 7 to 9 (Whiteneck & Dijkers, 2009). Badley (2008) argues that key characteristics of Participation are role performance and interaction with others. However, emphasis on these characteristics excludes participation in activities that are meaningful and goal directed without involving others. This study is focused on IEP goals involving communication and interaction with others as a prerequisite. Therefore, the assignment of Activity or Participation codes was guided by Whiteneck and Dijkers (2009), viewing the first six chapters as Activity, because these describe individual actions not necessarily involving others; and the last three chapters as Participation, because these involve actions with others and societal roles. Using the constructs of Activity and Participation when linking IEP goals to ICF-CY codes makes it possible to explore whether the IEP goals contain an individual or societal focus. The aim of this study was to explore how the contents of communication-related IEP goals are distributed according to the ICF-CY model. An additional aim was to explore whether the contents of the communication-related IEP goals for children with complex communication needs mirror the paradigm shift from the individual level to focusing on the
43
societal level of functioning, as operationalized through codes in the components and chapters of the ICF-CY. The following research questions were investigated: (a) How many ICF-CY codes are assigned to communication-related IEP goals at the component level? (b) How many ICF-CY codes are assigned to communication-related IEP goals at the chapter level? (c) How many ICF-CY codes in Activity and Participation are assigned to communication-related IEP goals?
Method Participants A total of 43 IEPs of students with complex communication needs were collected as part of the data collection process for development of the Communication Supports InventoryChildren & Youth (CSI-CY; Rowland et al., 2012). Recruitment efforts targeted educators and school-based speech-language pathologists who were responsible for writing communicationrelated IEP goals for currently served students with complex communication needs in grades K-12. All recruitment took place in the US. Announcements outlining the aim of collecting information on communication-related educational goals of children who used, or potentially could benefit from AAC, were posted to professional listservs and at various professional conferences. Participants were offered a gift card in the amount of $100.00 as compensation for providing the data. All study tasks were approved by the Institutional Review Board of the Oregon Health & Science University. As seen in Table 2, 43 special education teachers and speech-language pathologists from 17 states participated in the study. The participants reported considerable experience of work with children with complex communication needs, moderate knowledge levels of AAC, and limited knowledge of the ICF-CY. No information was provided about whether
Table 2. Background Information About Professionals (N ¼ 43).
Profession Special education teachers Speech-language pathologists Other Work setting Special day school Elementary school Secondary school Combined school settings Other Experience of children with complex communication needs 1-5 years 6-10 years 11-20 years 21 years or more Length of time working with the child 1 to 6 months 1 year or more Unknown AAC knowledge No or little knowledge Moderate knowledge Extensive or expert knowledge ICF knowledge No or little knowledge Moderate knowledge
n
%
17 24 2
39.5 55.8 4.7
5 12 10 15 1
11.6 27.9 23.3 34.9 2.3
10 14 5 14
23.2 32.6 11.6 32.6
10 22 11
23.2 51.2 25.6
3 25 15
6.9 58.1 35.0
41 2
95.3 4.7
44
N. KLANG ET AL.
speech-language pathologists worked according to pullout or classroom-based models of service delivery. However, most of the participants were well acquainted with the children and reported that they had been working with the targeted child for more than 1 year. The targeted students were between 5 and 20 years old (M ¼ 12) and were enrolled in elementary school, middle school, or secondary school (see Table 3). The most frequently identified disability categories for the targeted students were autism spectrum disorder, cerebral palsy, and intellectual disability.
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Material The communication-rated goals included both annual goals and related short-term objectives. In total, the IEPs contained 428 annual goals and short-term objectives related to communication. The number of goals and objectives per IEP varied from one to nine goals (M ¼ 3) and one to 18 short-term objectives (M ¼ 7).
Table 3. Background Information About Students (N ¼ 43).
Age 3-5 6-9 10-12 13-18 19-21 Gender Female Male Grade level of targeted student Elementary school (Grades 1 to 6) Middle school (Grade 7 to 8) Secondary school (Grade 9 to 12) Reported disability categories ASD Cerebral palsy Intellectual disability Other
n
%
2 11 7 21 2
4.7 25.6 16.2 48.8 4.7
13 30
30.2 69.8
16 12 15
37.2 27.9 34.9
13 9 8 13
30.2 20.9 18.7 30.2
Data Analysis Linking rules were used together with rules of content analysis to divide the texts of IEP goals into meaning units, extract meaningful concepts, and assign ICF-CY codes to the extracted concepts (Cieza et al., 2005; Graneheim Ha¨llgren & Lundman, 2004). According to linking rules (Cieza et al., 2005), meaningful concepts must be extracted from texts before assigning ICF-CY codes. Meaning units were defined as words, sentences, or paragraphs containing aspects related to each other through their content. Every goal and every objective was considered as a separate meaning unit. Within every goal and objective, meaningful concepts were extracted, in accordance with ICF linking rules (Cieza et al., 2005). Four types of meaningful concepts (MC) were discerned. These are displayed in Table 4 together with examples. In the ICF-CY, an alphanumeric system is used, in which letters and numbers denote different levels in the hierarchy of the classification. The letters b, s, d, and e are used for the components Body Functions, Body Structures, Activities and Participation, and Environmental Factors. The letters are followed by a numeric code to denote chapter number (first level), followed by the codes on the second, third, and fourth levels. The meaningful concepts were linked to the most precise ICF-CY code on the first, second, third, or fourth levels. In addition, in accordance with linking rules (Cieza et al., 2005), categories Not Definable, and Not Covered were assigned to the meaningful concepts, if the concepts could not be linked to the most precise ICF-CY code or were not covered in a classification. In this study, the division between Activities and Participation was made in accordance with one of the options of the ICF-CY: viewing the first six chapters as Activity and the three last chapters as Participation (Whiteneck & Dijkers, 2009; WHO, 2007). Thus, a distinction was made between goals that focus on the decontextualized use of skills in communication and the use of communication skills to participate in interaction with others, in school activities, and in leisure activities. Inter-rater reliability was checked three times. Initially, it was conducted for 10% of the material (43 goals). Based on the
Table 4. Example of Linking IEP Goals and Short-term Objectives to the ICF-CY Codes.
Type of meaningful concept
MC1 Support provided for the task
MC2 Communicative mode/AAC
Given descriptive text and two images,
By directing action and/or commenting on activity 2x per session 4 out of 5 charted trials d3500, d3501 [Student] will demonstrate knowledge of vocabulary
Example (goal 23) ICF-CY code Example (goal 29) ICF-CY code Example (goal 267) ICF-CY code Example (goal 189) ICF-CY code Example (goal 350)
ICF-CY code
e1300 During structured tasks with prompts e1301 As directed by her learning partner e3
d133 [Student] will use his SGD d360 Will navigate his SGD d360 Will maintain communication skills
d3500
MC3 Purpose of communication
MC4 Broader context for the task [Student] will engage in cooperative play with a peer d7504
By matching the text to the correct image with 85% accuracy. d1402 Commenting or answering questions d3501 To find pages, words, phrases and sentences Not Definable To participate and respond to social interaction activities with a given communication partner d750
Participate in group learning activities d8201
As seen in Figure 1, the IEP goals were primarily focused on the component of Activities and Participation, followed by Environmental factors. Few goals focused on the component of Body functions. The category Not Definable was assigned to six meaningful concepts in the texts of goals and objectives, indicating that few meaningful concepts were difficult to assign to a precise ICF-CY code. None of the IEP goals were assigned the categories Not Covered or Personal Factors.
ICF-CY Codes Assigned at the Chapter Level In Figure 2, the results of linking at the chapter level are presented. In Body Functions, Chapter 1, Mental Functions (e.g., developing awareness of one’s own mouth structure) and Chapter 3, Voice and Speech Functions (e.g., articulating), are targeted in the goals. In Activities and Participation, all
500
469
450
Number of codes
400 350 300 250 200
154
150 100 50
22
0 Body Structures
Body Functions
Activities and Participation
Environmental Factors
ICF-CY components Figure 1. The number of ICF-CY codes assigned to IEP goals and objectives at component level.
250 197
200
145
150
126
100
76
50 10
1
11
19
45
Results ICF-CY Codes Assigned at Component Level
discussion of initial inter-rater reliability, additional rules, and a coding scheme were elaborated. The coding rules concerned how to extract four specific types of meaningful concepts in texts of IEP goals before assigning an appropriate ICF-CY code (see Table 4). The coding scheme contained examples of meaningful concepts and assigned ICF-CY codes. When the first author completed the linking process, the sixth author linked 25% of the material (107 goals and objectives). Interrater reliability, calculated by dividing the number of agreements for meaningful concepts by the total number of meaningful concepts, was 62% on the most detailed levels (third and fourth levels). Analysis of disagreements showed systematic patterns of disagreement, for example, where writing was viewed as communication (d3) by one researcher and learning by the other (d1). The patterns were discussed and, based on the results of the discussions, the coding of IEP goals containing that kind of meaningful concepts was revised. Inter-rater reliability after discussions was 92% on the third level and 66% on the fourth level.
Number of codes
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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION
28 2
2
6
13
8
0
ICF-CY chapters Figure 2. The number of ICF-CY codes assigned to IEP goals and objectives at chapter level.
1
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chapters are focused in the goals. However, the majority of ICF-CY codes were assigned in Chapter 1, Learning and Applying Knowledge; Chapter 3, Communication; Chapter 7, Interpersonal Interactions and Relationships; and Chapter 8, Major Life Areas. In Environmental Factors, only codes from three of five chapters were used: Chapter 1, Products and Technology, containing codes on assistive technology as well as materials and methods of teaching, were assigned most codes, followed by Chapter 3, Personal Support; and Chapter 5, Systems, Services, and Policies. Few goals were linked to Chapter 3, Personal Support, which indicates that social support from teachers and peers is sparsely documented in the communication-related IEP goals.
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ICF-CY Codes Assigned per Activity and Participation Applying the distinction between Activities and Participation, the first six chapters are viewed as Activity and the three remaining chapters are viewed as Participation. Summarizing the number of codes per chapter according to this division resulted in 352 codes in Activity and 117 codes in Participation. Thus, the results indicate that relatively few goals focus on broader outcomes in terms of interaction, participation in school, and leisure activities.
Discussion The aim of the study was to explore how the contents of communication-related IEP goals for children with complex communication needs are distributed according to the multidimensional model of the ICF-CY. An additional goal was to explore whether the contents of the communication-related IEP goals mirror the paradigm shift from focusing on the individual level of functioning to the societal level, as analyzed through the constructs of activity and participation in the ICFCY. The results show that IEP goals focus on ICF-CY components Activities and Participation and Environmental Factors as well as Body Functions. It can be concluded that the IEP goals in US schools reflect the broad range of ICF-CY codes that have been suggested in the assessment of communication in previous research (Bornman & Murphy, 2006; McLeod & Threats, 2008; Raghavendra et al., 2007; Rowland et al., 2012; Simeonsson, 2003). The results also reveal that IEP goals focusing on Activity are more frequent than goals focusing on Participation. The IEP goals tend to focus on individual acts by the children such as learning and communicating through different modes, but to a lesser extent on interacting with others and participating in classroom-related and leisure activities. The fact that the number of codes denoting Participation constitutes approximately one-third of the total number of codes in the component Activities and Participation indicates that a shift toward participation goals is not fully realized.
Environmental Factors in the IEP Goals It is important that Environmental Factors are documented in IEPs because several factors in classroom and school environments can influence children’s participation
(De Bortoli et al., 2011; De Bortoli et al., 2014). However, previous analyses of IEPs for children with disabilities reported that IEPs contain a small amount of information concerning environmental factors (Castro et al., 2014; Sanches-Ferreira et al., 2013). In this study, a considerable number of codes were assigned to the ICF-CY component, Environmental Factors. More detailed analysis at the chapter level reveals that codes in Chapter 1, Products and Technology, concerning assistive technology and materials and methods of teaching, were most frequently used. Fewer codes were assigned to Chapter 3, Personal Support, concerning support from teachers and peers. Studies have shown that students with complex communication needs need support to be able to actively participate in classroom activities (Bunning et al., 2013; Chung et al., 2012; Raghavendra et al., 2012). The importance of communication partners has been emphasized as a prerequisite for success in interventions (Blackstone et al., 2007; Light & McNaughton, 2014). It may be important to further investigate how social and emotional support and attitudes of teachers and peers can be documented in IEPs.
Activity and Participation in the IEP Goals In the field of AAC, the importance of broader outcomes with a focus on participation and use of communication skills in interaction with others is emphasized (Blackstone et al., 2007; Calculator, 1999; Light & Drager, 2007; Light & McNaughton, 2014; Pless & Granlund, 2012). The secondary aim of this study was to explore whether the paradigm shift calling for a focus on societal aspects of students’ participation is mirrored in the communication-related IEP goals. This was studied with the help of the constructs Activity and Participation in the ICF-CY, the former focusing on the individual perspective and the latter on the societal perspective. The results of the study show that the number of codes in Participation only accounts for one-third of the codes assigned to the Activity and Participation component. The results can be partly explained by the uneven distribution of the codes in the ICF-CY classification, with six chapters aligned to Activity and three chapters to Participation dimensions. Viewed at chapter level, the IEP goals focus on learning (Chapter 1, Learning and Applying Knowledge) and communication skills (Chapter 3, Communication) to a greater extent than on using communication skills in actual interaction with others (Chapter 7, Interpersonal Interactions and Relationships) or participating in school and leisure activities (Chapter 8, Major Life Areas). It is encouraging that the IEP goals focus on children’s functioning in everyday school environment, especially on language acquisition and communication skills, as these are prerequisites for students’ participation (Granlund, 2013). However, there seems to be a need to support professionals in formulating broad goals with a focus on children’s participation and addressing the use of communication skills in interaction with others and in school activities. Participation-focused goals concern a child’s social involvement and presuppose his or her direct involvement in goal setting. In this study it is not known to what degree the children were active in the IEP development process. Although the adults may consider the child’s
AUGMENTATIVE AND ALTERNATIVE COMMUNICATION
perspective and his or her best interests, they cannot actually take the child’s own perspective (Nilsson et al., 2015). Giving voice to the perspective of children themselves will most likely enhance children’s motivation to engage actively in important interventions.
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Limitations The results of the study must be treated with caution due to the limited number of IEP goals included in the analysis. The examined IEPs are related to the context of only one country, the US, and thus must be interpreted in that context. However, examination of the IEP goals may have implications for IEPs developed in other countries. The goals and short-term objectives were nested within IEPs, thus resulting in limited variation in the goals and objectives. Furthermore, the conclusions from the study are based on professionals’ documentation of IEP goals. The study did not consider other components of the IEPs outside of the educational goals and objectives, such as the methods chosen to implement IEPs or how selected goals were related to individual child characteristics. A more detailed analysis that includes interviews with professionals and examining other IEP components may be needed to achieve a better understanding of the focus of communication interventions in educational contexts. In this study, there was no information about the level of inclusion of the targeted students in educational settings. Previous studies reveal that formulation of IEP goals may be different, depending on whether or not students are placed in inclusive settings (Kurth & Mastergeorge, 2011 therefore, there may be a need for data on the degree of a student’s educational inclusion, in order to provide insights into background factors related to goal-setting.
Conclusion This study was informed by the need to investigate the content of communication-related goals developed for students with complex communication needs. The results indicate that, while the IEP goals contain information related to several components of the ICF-CY, few goals are formulated in terms of participation. Although the division between Activity and Participation used in this study may have influenced the results, the fact that IEP goals contain a relatively small amount of information on interaction with others and participation in school and leisure activities is noteworthy. This suggests an individual focus in terms of intervention outcomes rather than a societal focus, which would include the child’s participation in activities that are meaningful and that involve interaction with other people. Given the participation challenges faced by students with complex communication needs in classroom activities, it is important that communication-related IEP goals explicitly target participation outcomes. Additionally, the provision of social and emotional support by professionals was addressed infrequently in IEPs. This could be an enhanced focus for discussion in future IEPs.
Disclosure statement The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.
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