Abstract

The current article is a description of a unique service learning activity developed to enrich graduate student knowledge in the prevention of speech and language disorders with at-risk populations. Graduate students enrolled in a communication disorders program at an upper division Midwestern university participated in the development and facilitation of a workshop for parents of children 0-5 years at risk for speech and language disorders. Student reflection data revealed increased knowledge of prevention in communication disorders, confidence in collaborating with parents for future practice, greater experience collaborating with peers, and a desire to provide similar workshops for the community.

Purpose

Graduate students in communicative sciences and disorders enter their programs enamored with the possibility of changing the lives of the more than 1.4 million children receiving services for speech, language, and hearing disorders in the United States (American Speech Language and Hearing Association, 2008). Communication disorders are among the most common disabilities in the United States. There are several kinds of disorders which come under the umbrella of communication; the more common disorders in children are delays in speech and language acquisition, including phonological disorders. According to the American Speech Language and Hearing Association (ASHA), a language disorder may be defined as the impaired comprehension and/or use of spoken, written, and/or other symbol symptoms. Most children with language disorders present with early delays, resulting in impaired developmental and functional skills upon school entry. ASHA reports the prevalence of language difficulty in preschool children to be between 2% and 19%. The development of language is intimately linked with reading and writing skill development. Spoken language (listening) skills in particular provide a foundation for later reading and writing progress. Children who have problems with spoken language will frequently experience difficulties learning to read and write (ASHA, 2006).

A phonological disorder (classified as a speech disorder) is an impaired comprehension of the sound system of a language and the rules that govern the sound combination (ASHA, 2008). Simply put, children presenting with this disorder do not use the speech sounds expected for their age group, which may impede overall speech intelligibility. There is often an observed relationship between early phonological disorders and subsequent reading, writing, and spelling abilities. School reports from 2006 indicate that approximately 91% of speech-language pathologists (SLPs) serve individuals with phonological/articulation disorders (ASHA, 2008).

Graduate program curricula emphasize the study of assessment and treatment of such disorders. Students must demonstrate the ability to effectively select the most appropriate assessment tools and construct creative and developmentally appropriate plans for intervention.

While the principal focus of the profession (assessment and intervention) continues to be important, the scope of practice must be expanded to include the prevention of communication disorders (ASHA, 1988). The chance to explore real-life cases related to eliminating the onset of communication disorders, however, may be difficult to acquire and a major concern for those seeking to work with early intervention populations in particular. Families primarily served through early intervention represent a growing number of culturally and linguistically diverse and low-income or low-resource populations. Environmental factors such as decreased vocabulary, limited access to literacy resources, and poor nutrition often place them at greater risk for communication disorders (Stanton-Chapman, Chapman, Bainbridge, & Scott, 2002; Walker, Greenwood, Hart, & Carta, 1994). Thus, it is imperative that future speech-language pathologists are provided with the quality experiences necessary to meet the needs of these families (ASHA, 2002). One way that a quality experience can be achieved is by providing individual-, family-, and community-focused prevention information and services such as workshops to teach families strategies for enriching language and literacy development in young children.

A viable solution for closing what appears to be a gap between student learning in the classroom and real life experience is to take a service learning approach. Defined as a teaching and learning method, service learning integrates classroom curriculum with community service to enrich learning, build stronger appreciation for the discipline, and encourage civic responsibility (Bringle & Hatcher, 1996; National Service-Learning Clearinghouse, 2011). According to Bringle and Hatcher (1996) “faculty who use service learning discover that it brings new life to the classroom,…increases student interest in the subject, and teaches problem solving skills…” Graduate students’ interest in service learning may be due to the active role they take in the identification, development, and accomplishment of projects. In addition, service learning can accommodate a range of learning styles, offering the opportunity for all students to achieve optimal results. This article will describe a unique service learning activity developed to increase student knowledge of the prevention of speech and language disorders and serve as a pilot for future related research. It is hoped that this example of service learning will help other students and professionals gain a better understanding of their responsibilities relative to prevention and the multitude of available opportunities.

Rationale

Preventing communication disorders is one of the primary responsibilities of speech-language pathologists and includes the development and application of prevention strategies as well as the expansion of related research (ASHA, 2008). Research has shown prevention efforts to be effective in reducing the prevalence of communication disorders such as hearing loss and prevention is also more cost-effective when compared to alternative costs of rehabilitation (Gerber, 1998). Initiatives for the promotion of health, the protection of health, and the provision of preventative health service have been around since the early 1970s with many having positive effects on the prevalence of communication disorders (Popich, 2003). The investigation and prevention of human communication disorders is incorporated into the ASHA by-laws (American Speech Language and Hearing Association, 1988) at three levels:

• Primary: Eliminating the onset and development of communication disorders through dissemination of information, health education, and training of future practitioners and related service professionals
• Secondary: Treatment of a communication disorder in its early stages mainly through screenings and early detection
• Tertiary: Reduction of disability through management of the problem, rehabilitation, and intervention

Graduate programs provide extensive training in the secondary and tertiary levels within the contexts of both classroom and practicum experiences; however, students may feel less equipped to serve clients at the primary level as there appear to be fewer opportunities to apply knowledge obtained in lecture and required readings to a real-life setting. Providing students with an opportunity to disseminate early speech and language development information to parents through health education is a necessary step for optimizing their training in speech-language pathology.

Students must be equipped to share vital information with parents, the child’s first teacher. The development of a child’s language and phonological skills stem from quality early learning experiences most effectively initiated by parents. As the constant in a child’s life, parents are responsible for monitoring the child’s development of social, emotional, physical, and communication skills. They therefore play a crucial role in preventing disorders while assisting them to develop in each of these areas. Zubrick, Clezy, Stokes, and Whitehall (1996) suggest that there are a number of methods that might be used to prevent child language disorders, including the identification of appropriate expectations and overall physical and emotional nourishment. Specific strategies and activities for preventing speech and language disorders may involve parents implementing one of more of the following: (a) using gestures during early learning to increase expressive language skills; (b) utilizing parallel talk to describe a child’s actions as they are doing them; (c) asking a variety of questions using a developmentally appropriate hierarchy; (d) giving the child a variety of experiences with people, places, and things; (e) encouraging the use of words to request wants and needs; (f) encouraging pretend play with familiar items; (g) modeling a balance of age appropriate language and new and interesting words; and (h) participating in interactive reading experiences. Unfortunately, many parents may not be aware that these strategies and activities can be implemented within purposeful daily interactions and decrease the likelihood that their children will experience speech and language delays and later, potential learning difficulties.

Service learning can fulfill two purposes, firstly in increasing knowledge about the prevention of communication disorders and secondly in providing parents with the tools they need to prevent communication disorders. Service learning can provide such opportunities because it takes the perspective of a hands-on approach to mastering subject matter while fostering civic and, in this case, professional responsibility. Overall, service learning adds a “richness and reality” to the academic experience as students learn to fuse the elements of what they already know with what they learn from the encounter with community (Hara, 2010). It is believed that communication disorders programs are perhaps ideally suited for service learning because students often enter the major due to a strong interest in serving their communities (Peters, 2011).

In addition, service learning within the context of the project described here will also serve to provide speech-language pathology students with experiences working with diverse populations. Boyle-Baise (2002) found that when teacher candidates have authentic experiences within communities different from their own, they change their preconceived perceptions about others and feel more confident about their ability to work in diverse settings. These principles should be applied to future speech-language pathologists as well by providing them with meaningful interactions with diverse populations.

Finally, as students participate in service learning activities surrounding the prevention of speech, language, and hearing disorders, they will learn strategies and creative methods for communicating with families and early childhood educators that will assist them in providing a higher quality of service in the future. General consensus among early childhood literacy experts suggests that parents are a key piece of the puzzle when it comes to a child’s development. The frequency and quality of interactions play a specific role in all that concerns learning. Literature supports a strong relationship between early parent-child interaction and later skill development (Dodici, Draper, & Peterson, 2003).

The Participants

Students enrolled in a master’s level graduate program at an upper division university in the Midwest were identified for participation in the service learning project. The university‘s programs are specifically designed to meet the needs of nontraditional students. Participation in service learning is of particular importance as students prepare to interact with diverse populations. Graduate student enrollment in the Department of Communication Disorders was comprised of 122 students during the fall 2010 semester, which was somewhat less diverse than the university as a whole; only 27% of students were categorized as minorities (e.g., Asian-American, African-American, Hispanic, Pacific Islander). Therefore, the majority of student participants found themselves introduced to populations outside of their own racial/ethnic and/or socioeconomic cultures for the first time upon beginning their studies in the field of speech- language pathology. A current examination of United States census reports indicate that the idea of a majority group will disappear within the next few decades as the non-Hispanic White population grows at a slower rate and the Hispanic and Asian populations increase due to higher levels of immigration (United States Census, 2010). Future professionals should therefore be prepared for the increase in diversity that will likely result in greater needs for individuals and families.

There were 44 students identified for participation in this research. At the time of data collection, twenty-five students (92% Caucasian; 8% African American) were enrolled in Advanced Assessment and Intervention in Communication Disorders (CDIS 6200) and nineteen students (94% Caucasian; 5% African American) were enrolled in Language Disorders: Early Stages (CDIS 7500). CDIS 6200 is intended to provide students with skills and knowledge of assessment, remediation, and prevention of speech and language disorders required for all professionals in communication disorders. Students enrolled in this course are required to complete a number of activities that emphasize the process of assessment and intervention. In addition, they are required to complete a project that focuses on one aspect of prevention. Topics covered include ethnographic interviewing, identification of well-standardized assessment tools, goal writing, treatment planning, and serving culturally and linguistically diverse populations.
Students enrolled in the CDIS 7500 course focus on the identification and treatment of children with language disorders from birth through age five. Topics covered include emergent literacy, assistive technology, family-centered intervention, developmentally young clients, informal assessment, and serving culturally and linguistically diverse families.

The Service Learning Project

The facility identified for the service learning project is a family development center located on the university campus. Approximately 70% of the children served within this facility are eligible to receive free or reduced meals. Demographic makeup is diverse and is comprised of 13% Hispanic/Latino, 67% African American, 31% White, 6% Asian, 6% Pacific Islander, and 6% Native American. Both socioeconomic and minority status are variables to be considered in children who are at risk for speech, language, and hearing disorders, thus making this facility appropriate to host a discussion on prevention (personal communication, June 28, 2011).
In an effort to expand roles to include the prevention of speech and language disorders, SLPs should present primary prevention information to groups known to be at risk for communication disorders (ASHA, 1988). The instructor contacted the university’s family development center to discuss possible collaborative activities that would provide students with an opportunity to experience a hands-on approach to learning about the prevention of speech and language disorders. It was determined that students would demonstrate the prevention of speech and language disorders through parent education. Students and the instructor would co-facilitate a workshop emphasizing language and literacy development and enrichment in young children (0-5 years).

To ensure students were equipped with necessary knowledge and tools before beginning the project, the instructor provided lectures in both CDIS 6200 and CDIS 7500 discussing the relevance of prevention in the practice of speech and language pathology and identified related terminology (i.e. primary prevention, secondary prevention, tertiary prevention, at-risk, incidence, and prevalence). The role of the SLP as it pertains to prevention includes the responsibility to provide information and advice to parents and families. Areas which may be covered in discussion with families include typical and atypical language development, vocabulary development, phonological awareness, and pre-literacy skills. Thus, an additional lecture in each course provided a review of language and literacy skill development in young children.

The instructor introduced the topic of prevention, but students’ input regarding logistics was also encouraged. Specifically, students constructed the format of the workshop to include lecture, hands-on experiences, and discussion. They also determined the topics to be included under the umbrella of language and literacy development.

The strong connections among phonological awareness, spoken language, reading, and writing support the selection of language and literacy enrichment as the subject matter for the parent workshop. Together they provide a foundation for developing successful communication skills in young children. Students identified specific skills related to the development of language and literacy in children 0-5 years. Examples of topics decided upon for the parent workshop include:

• How to make the most of reading books
• Language learning through pictures/photos
• Language learning in five minutes or less

Students organized themselves into groups of no more than four and followed instructions provided by the instructor:

• Develop interesting activities that would encourage hands-on parent participation during the workshop.
• Develop feasible activities that would allow for and encourage parents to reproduce them at home with their children.
• Develop a “take-away” for parents, including resources to encourage continued learning.

Over the course of approximately four weeks, students met and developed a series of educational opportunities to meet these specifications. Group meetings occurred during class and during meetings with the instructor outside of class.

Each group successfully completed at least one hands-on activity to be shared with parent participants at the workshop. The course instructor acted as the facilitator for the workshop and provided participants with information on the role of the speech-language pathologist and signs to look for relative to typical and atypical language development. A description of the workshop’s purpose and subsequent activities was also explained.

The following is a brief description of activities in three of the selected topics:

• How to make the most of book reading:
• Parents were shown how to reinforce pre-literacy knowledge through the development of activities related to their children’s favorite books. For example: Creating a door hanger for “Chicka Chicka Boom Boom,” decorated with pictures recalled from the story.
• Language learning through pictures/photos:
• Parents were shown how to increase language skills using photographs and pictures of familiar scenes (playground, beach, and zoo). After a background scene (beach, movie theater, etc.) was selected, a photo of the participant was taken and integrated into the scene. Participants were told that they might encourage children to create a story based on the new picture, use related vocabulary and respond to ‘Wh’ questions.
• Language learning in five minutes or less:
  • Participants were given a number of activities to increase child language skills that could be completed in five minutes or less, such as learning nursery rhymes, songs and rhythms, creating a reading tree to provide a visual of books read together, and using a calendar to increase ability to respond appropriately to ‘Wh’ questions.

Findings

A critical reflection of the service experience is a fundamental component of service learning. Encouraging students to reflect on their experiences facilitates making connections between their service learning and their classroom learning (National Service-Learning Clearinghouse, 2011). The 44 students who participated in the workshop were asked to reflect on their experience in response to two open-ended questions. The questions focused on how the experience increased their knowledge of the prevention of speech and language disorders and how they thought it might influence future clinical practice:

1. What did you gain from this experience that you can use as a student of speech and language pathology?
2. What did you gain from this experience that you can/will use as a practitioner in the field of speech and language pathology?

The fifteen parents attending the workshop were also asked to share their thoughts on the experience through a conversational open-ended interview. The instructor asked parents what they would be taking away with them from the experience.

Responses obtained from the open-ended questions were examined using content analysis. For each of the open-ended questions (students and parents), responses were divided into thematic recording units and separated into categories within each theme. The themes were chosen to represent the most commonly occurring responses provided for each question. Participants’ responses were then grouped into the common themes and categories identified for each question. Each individual response was eligible to be classified into any theme, giving every participant’s response the potential to correspond to more than one of the themes created for each question; however, participants’ responses for each question could only be counted once for each of the corresponding themes.

Responses from the two open-ended questions posed to students indicated that outcomes concentrated in the areas of knowledge and self-confidence. In response to question #1 regarding gains obtained during the workshop that can be used as a student, participants indicated greater overall knowledge in the prevention of speech and language disorders, an appreciation for experiential learning, and greater and more productive experiences in collaborating with peers in small and large group settings. In response to question #2 regarding gains from the workshop that can be used as a practitioner in the field, participants indicated greater knowledge and confidence in collaborating with parents and greater confidence in developing functional language and literacy activities for use with children 0-5 years. Students expressed a desire to provide similar workshops for the community in response to both questions.
Parent responses to what they would “take away” with them from the workshop centered on the theme of increased knowledge. Parents reported a greater understanding of the roles and responsibilities of an SLP and increased knowledge of new, inexpensive, and quick ways to improve children’s language and literacy skills within the home environment. Parents also reported a positive impression of student creativity and knowledge relative to the subject of language and literacy.

Discussion

The present study was designed to gain preliminary information regarding the effect of service learning in teaching graduate students about the prevention of communication disorders in children 0-5 years. Through the education of parents in a language and literacy enrichment workshop, students applied classroom knowledge in a real-life context.

Themes derived from student responses indicate increased learning (knowledge) through a real-life context, increased confidence in developing language- and literacy-based interventions for young children, greater confidence in collaborating with parents in the future, and developing interest in providing additional prevention opportunities within the community. These responses are consistent with identified benefits of service learning, which include an increase in students’ self-confidence, social responsibility, self-esteem, personal advocacy, higher level thinking skills, appreciation for other cultures, and development of future workplace skills (Simons & Clearly, 2011; Kezar & Rhodes, 2001).

Themes derived from parent responses suggest positive implications for increasing the use of strategies to enrich language and literacy skill development in the home. Increased knowledge of language and literacy strategies by parent participants also suggests the possibility of decreasing the number of communication disorders in the United States through primary prevention information.

The results support the hypothesis that service learning experiences provide students with the opportunity to increase in academic knowledge, self-confidence, development of future workplace skills, and desire to serve their communities.

Implications

This study found that service learning experiences can contribute to students developing academic, personal, and content-related knowledge as well as increase the desire to become involved in further service to the community. The findings from the students’ responses to the reflection questions are evidence of the many benefits that can occur when service learning opportunities are included into course and program requirements. As demonstrated in this preliminary research, students have the potential to increase both knowledge and confidence when exposed to service learning opportunities. In addition, parents also have the potential to increase knowledge.

This research may be of particular interest to professors in Communication Disorders and similar fields, as university training programs have a responsibility to students to provide creative opportunities such as those described here to expand academic knowledge, address the needs of the community at large and provide more effective service to those at risk for communication disorders. Service learning can address these needs while complementing classroom and text book teaching methods. Current research is lacking to appropriately evaluate the development of knowledge and skills in the area of prevention as a result of participating in a service learning experience. Additional research in this area would provide advanced knowledge about the specific effects and influences of such experiences with students studying communication disorders.

This research also contributes to the dearth in the literature concerning nontraditional students and service learning. Service learning experiences provide these students with an opportunity to gain a better understanding of themselves and ways to contribute their strengths to the learning environment and leadership in the community.

References

American Speech-Language-Hearing Association (2008). Incidence and Prevalence of Communication Disorders and Hearing Loss in Children. Available from http://www.asha.org/research/reports/children.htm

American Speech-Language-Hearing Association. (2002). Knowledge and Skills Needed by Speech-Language Pathologists With Respect to Reading and Writing in Children and Adolescents [Knowledge and Skills]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association (1988). Prevention of Communication Disorders[Position Statement]. Available from www.asha.org/policy.

Boyle-Baise, M. (2002). Multicultural service learning: Educating teachers in diverse communities. New York: Teachers College.

Bringle, R.G. and Hatcher, J.A. (1996). Implementing service learning in higher education. Journal of Higher Education, 67, 67-73.

Hara, B. (2010, July 8). Service learning (for students) [Web log post]. Retrieved from http://chronicle.com/blogs/profhacker/service-learning-for- students/25360

Gerber, S. (1998) Etiology and prevention of communication disorders. Delmar Cengage Learning.

Kezar, A. & Rhoads, R. A. (2001). The dynamic tensions of service learning in higher education: A philosophical perspective. The Journal of Higher Education, 72, 148-171.

Morrison (personal communication, June 28, 2011) noted Family Development Center racial/ethnic demographics.

National Service-Learning Clearinghouse (2011). What is service learning? Retrieved from www.servicelearning.org

Peters, K. A. (2011). Including service learning in the undergraduate communication sciences and disorders curriculum: benefits, challenges, and strategies for success. American Journal Of Audiology, 20(2), 181-96.

Popich, E. (2003). The development of a tool for parents for the stimulation of communication skills in infants (0-12 months) (Doctoral dissertation, University of Pretoria).

Ruben, R.J. (2009). Redefining the survival of the fittest: Communication disorders in the 21st century. The Laryngoscope, 110:241. doi: 10.1097/00005537-200002010-00010.

Service Learning Resources (2006). Illinois State Board of Education.

Simons, L. & Cleary, B. (2006). The influence of service learning on students’ personal and social development. College Teaching, 54(4), 307-319.

Stanton-Chapman, T.L., Chapman, D.A., Bainbridge, N.L. & Scott, K.G. (2002). Identification of early risk factors for language impairment. Research in Developmental Disabilities, 23, 390-405.

U.S. Department of Education, National Center for Education Statistics (2011). Digest of Education Statistics, 2010 (NCES 2011-015). Table 45.

United States Census (2010). Overview of race and Hispanic origin: 2010. Retrieved from United States Census 2010 website: http://www.census.gov/2010census/data/

Walker, D., Greenwood, C., Hart, B., & Carta J. (1994). Prediction of school outcomes based on early language production and socioeconomic factors. Child Development, 65, 606-621.

Zubrick, A., Clezy, G., Stokes, S., & Whitehall, T. (1996). Communication disorders: An introduction for community based rehabilitation. Hong Kong University Press.

About the author:

Jennifer Armstrong

Jennifer Armstrong Ph.D., CCC-SLP is a professor in the department of Communication Disorders at Governors State University. Dr. Armstrong has provided instruction for undergraduate and graduate students in assessment & intervention and early language disorders for several years. Her current research involves service learning and the prevention of communication disorders in young children.

Assistant Professor, Department of Communication Disorders, Governors State University, 1 University Parkway, University Park, IL 60484. jarmstrong@govst.edu

© 2014 Journal for Civic Commitment