FOCUS Outcome Measure - FAQs

Parents and toddler smiling together.

The FOCUS Team has compiled the most Frequently Asked Questions below.  
 


FOCUS Outcome Measure

Q1: On the first page of the FOCUS, there is a space for FOCUS completion #. What is this?

A: This refers to how many times the FOCUS has been completed for each child.

Q2: Is there a way for the parent to complete the FOCUS directly onto the computer?

A: Yes. There are now FOCUS pdf fillable forms available for both the parents and the clinicians. The forms are available for purchase on the CanChild website.

Q3: Please provide more detail regarding the observed box.

A: This box is for your clinical use. You check the Observed column when you have observed the child using the skill. The child may begin to use some communication skill/behaviours in your session and you observe them more frequently. This may indicate positive progress.

Q4: Can I just give Part 1 of the FOCUS?
A: No. The FOCUS must be completed in its entirety as it is a validate measure and change is based on the FOCUS total score.


FOCUS-34 Outcome Measure

Q1: I’ve been using the original FOCUS on my clients but would like to use the FOCUS-34. When would be the best time to introduce the FOCUS-34?

A: Continue using the original FOCUS on your existing clients and start the FOCUS-34 on new clients as they are enrolled in your program.

Q2: How do I compare the scores from the FOCUS and the FOCUS-34?

A: If clinical practice indicates a change to FOCUS-34, then take the Total Score from the original FOCUS and multiply it by 68/100. For example if the Total Score was 300 you would compute the following:

                                             300 x 68    =    204

                                                 100

 

The new Total Score is now 204 and this new score can be directly compared with the Total Score from the FOCUS-34.


FOCUS Development

Q1: How well does the FOCUS reflect change in lower functioning children who are slow to progress such as those using AAC?

A: Our research shows that the FOCUS does a good job of capturing change for these children. In fact, children who started using AAC devices showed a lot of change on the FOCUS.

Q2: Were children with multiple needs beyond just articulation and expressive language included in the testing sample?

A: Yes. Our sample included children who were diagnosed with developmental delays, cerebral palsy, ASD, hearing impairments and neurological disorders.

Q3: How do parents react if they answer “Not at all like my child” several items?

A: This may happen if the child is very young or has severe communication difficulties. If this happens, the speech-language pathologist should remind parents that their child is only being compared to themselves. Also, the FOCUS is designed to capture change across a range of years. No young child would receive high scores initially on the FOCUS as there has to be room to show change.

Q4: Is there a French version of the FOCUS?

A: The French version of the FOCUS (FOCUS-F) is available on the FOCUS webpage through Flintbox. There are several other translations of the FOCUS available.


Specific FOCUS Items

Q1: Does the manual describe each item and what is being targeted?

A: No. The FOCUS is designed to measure communicative participation (i.e. functional communication skills in a variety of settings) from a holistic perspective. We know that two different speech-language pathologists can read and interpret these items, independently and be reliable in their scoring of the FOCUS.

Q2: For Part 1, Item #3 “My child is comfortable when communicating.” How do you define comfortable?

A: In this context, the word ‘comfortable’ refers to both communicative intent (is the child trying to talk more) and/or emotion related to communication (i.e. are they less frustrated, have lower anxiety…).

Q3: How do we respond to Part 1, Item #3 “My child is comfortable when communicating” for children who are sociable but not communicating intentionally?

A: The FOCUS measures functional communication skills. If the child is not communicating intentionally, the correct response would be “Not at all like my child”. This way, change is captured when intentional communication emerges.

Q4: For Part 1 Item #6 “My child talks while playing.” Does this refer to babbling?

A: No. The FOCUS measures functional communication skills. If the child is not communicating intentionally, the correct response would be “Not at all like my child”.

Q5: For Part 1, Item #7 “My child is willing to talk to others.” Does echolalia count as talking?

A: The FOCUS is a measure of functional communication. Therefore, talking refers only to talking used to communicate. If the child uses echolalia with intent to communicate, this would count as ‘talking’.

Q6: For Part 1, Item #9 “My child can communicate independently.” Does this include signing or assisted communication by an adult or that the child initiates communication?

A: This is an attempt to measure how much help the child requires in order to communicate effectively and applies to any form of communication, including signed or assisted communication. What is important is how independently the child is able to communicate with a listener, ranging from not at all like my child to exactly like my child. If the listener needs help to understand the child, this means the child is not communicating independently.

Q7: For Part 1, Item #13 “My child can communicate independently with other children.” Can you please clarify what ‘independently’ means?

A: Independent means that the child does not need assistance to compose or reply to the speakers’ information AND the speaker does not need assistance understanding what the child is communicating.

Q8: For Part 1, Item #16 “My child speaks slowly when not understood.” Does this item refer to the child speaking slowly unprompted?

A: Yes it does. 

Q9: For Part 1 Item #19 “My child waits for her/his turn to talk.” Does this item also include nonverbal and alternate forms of communication?

A: Yes. This is the only exception. For the rest of the FOCUS, the word ‘talking’ refers to verbal communication. Since this item primarily evaluates turn taking skills, it includes verbal, nonverbal, PECS, AAC turn taking. The word ‘talking’ was used in this instance because our research proved that parents understood ‘talking’ better than the words ‘converses’ or ‘communicates’.

Q10: For Part 1 Item #19 “My child waits for his/her turn to talk.” Since this refers to any form of communication, can we add 'or communicate' to the item to clarify this for parents without impacting the validity?

A: No. FOCUS items have been carefully worded and tested with over 500 parents. The wording of the items has been selected for clarity, reliability and responsiveness. Do not change the wording of any of the items. If a parent asks for clarification or seems confused about the item when you review it with them, feel free to verbally clarify the item.

Q11: For Part 1, Item #23 “My child uses words to ask for things.” Does this refer to what they typically do?

A: Yes. Most FOCUS items refer to what the child typically does; however, the headings can also reflect how typically the child does something. For example, the response for a child who asks for things occasionally might be “A little bit like my child”.

Q12: For Part 1, Item #32 “My child is reluctant to talk.” What do we put when the child is not talking at all?

A: If the child is not yet talking, please score this item as “Exactly like my child”.

Q13: For Part 1, Item #32 “My child/client is reluctant to talk.” Does this ‘talk’ mean using AAC systems?  

A: No. This item only refers to verbal communication.

Q14: For Part 2, Item #1. “My child plays well with other children.” For children with motor impairments (i.e. a child with CP), do we include needing physical help for participation in activities or is the FOCUS only on the communication aspects?

A: Yes. The FOCUS measures the child’s ability to communicate and play with their peers in a variety of environments. This item measures how much assistance (including physical assistance) the child requires to play, irrespective of their diagnosis.

Q15: For Part 2, Item # 4 “My child is included in games by other children.” Is this answer dependent on other children?

A: Yes. This item reflects peer interactions between children. Research has shown that children with communication disorders are more likely to be socially excluded and ignored by their peers. It is, therefore, an important indicator of how successfully the child interacts with other children.

Q16: For Part 2, Item #9 “My child can respond to questions.” Does this item refer to talking or communicating? Can the response be through AAC and/or gestures (e.g., nodding).

A: Yes. This item refers to any type of communication such as AAC and/or gestures.


FOCUS Excel Scoring Sheet and Profile

Q1: Where is a downloadable/printable version of the Scoring Form and Profile available?

A: The Excel Scoring Sheet and Profile are available for purchase on the CanChild website.

Q2: Does it make sense to just use the Scoring Form, if the speech-language pathologist is scoring the FOCUS?

A: No. Please use the Clinician FOCUS form as there is no ‘Observed’ column on the Scoring Form.

Q3: When looking at Scoring Profile average scores; do you round off to the nearest whole number?

A: Yes. These scores are for your individual clinical use. It is important to remember that change is evaluated using the FOCUS total score. The profile helps clinicians to determine if there are areas where a lot of change has happened or conversely where little change has occurred. Clinicians are encouraged to only look at the rank order of the communication areas to determine areas of most/least change.

Q4: One parent marked an item twice. How should I score this?
A. For this item, use the lowest marked score.


FOCUS Procedures

Q1: Where do I find the FOCUS outcome measure?

A: The FOCUS outcome measure is available for purchase on the CanChild website.

Q2: Is it preferable to use the Parent FOCUS outcome measure and only use the Clinician FOCUS outcome measure if, for some reason, the parents cannot complete the outcome measure? 

A: Yes. Since the parents have the opportunity to observe their child in different environments, it is preferable to have the parent complete the FOCUS. If the speech-language pathologist is completing the FOCUS, they need to consult with the parents to obtain information about how the child communicates with others at home and in the community.

Q3: Is there a preferred time in which to administer the FOCUS (e.g., before or after a family receives feedback from an assessment)?

A: Parents can complete the FOCUS either before or after the assessment. This is left to your clinical judgment. Some clinicians ask the parents to fill out the measure while the child is being assessed. Others find it helpful to have the parents complete the outcome measure after the assessment so that the parents and clinicians have a common language.

Q4: Should speech-language pathologists coach the parents through the FOCUS items or should parents fill it out independently? Does the amount of coaching impact the validity?

A: FOCUS can be administered either way and it does not affect the validity. If the parent completed the FOCUS independently, we recommend that the clinician review it to check for missed items and to answer any questions. Use your clinical judgment about the best process for each family.

Q5: Can communication disorder assistants/therapy assistants coach the parents through the FOCUS items?

A: Yes. A communication disorder assistant/therapy assistant can assist the parents to complete the FOCUS.  It does not affect the validity. The speech-language pathologist, however, must be the one that scores and interprets the FOCUS results.

Q6: What if the clinician has never had an opportunity to observe the child with other children?

A: If you have not had an opportunity to observe your client with other children, ask the parents for their input.

Q7: Would you use the FOCUS with children who do not yet have intentional communication, do not initiate or respond to communication with others and have only random play with toys?

A: Yes. Please complete the FOCUS on all children who are 18 months or older based on chronological age.

Q8: What if different parents bring the children to re-assessment appointments?

A: It is ideal for the same parents to complete all FOCUS outcome measures, but it is not always possible. It is better to collect the data than to not complete the FOCUS.

Q9: How do you respond to the items relating to playing with other children if they are not around other children very much (i.e., home with parents/grandparent)?

A: Ask the parents. It is likely that the children play with some other children such as cousins, siblings and friends.

Q10: What if it is a different speech-language pathologist that fills out the FOCUS every time for the same child. Is that okay?

A: Yes. We have established inter-judge reliability with speech-language pathologists using the FOCUS.

Q11: What do we do if a family does not read English?

A: We have developed an audio version of the FOCUS. This version is also available for download from Flintbox.

Q12: Is it best practice is to have the parent complete the outcome measure during our session or can we send it home to be filled out and have it returned the following session?

A: Use your best clinical judgment and knowledge of the family to determine if this is a possible option for the family.

Q13: Do we complete the FOCUS as an interview if parents can't read?

A: If you feel the parents need assistance, then it is possible to do the FOCUS as a parent interview or you can download the audio version of the FOCUS from Flintbox.

Q14: Should parents ask for input from preschool/daycare centers when they are not sure how to answer an item?

A: Yes. Parents can ask Early Childhood Educators for input, if they would like more information to help them score certain items.

Q15: If you are interviewing a parent, do you complete the parent or the clinician outcome measure?

A: When interviewing the parent, you just record the parents’ answers for them using the FOCUS Outcome Measure - Parent.

Q16: Why do we use the FOCUS Scoring Profile?

A: The FOCUS scoring profile is optional. It can be used to obtain further information for clinical goal setting and treatment. Rank ordering of the average scores for each communication reveals where the child has made the most change in response to treatment and if there are categories that do show less change.

Q17: Can the FOCUS be used with a family who has limited English?

A: Yes. If the family has a limited knowledge of English then the FOCUS can be completed through parent/caregiver interview and/or with an interpreter as needed. The clinician should record the parent’s responses as given.

Q18: Can the FOCUS be completed with the parent over the phone?

A: Yes. The FOCUS can be completed over the phone. Again, the clinician should record the parent’s responses as given.

Q19: Can the FOCUS be printed on both sides of the paper?

A: No. In order to reduce errors and omissions while completing the paper copy of the FOCUS, it is recommended that the FOCUS be copied on single sheets of paper, not double sided.

Q20: What is the age range for the FOCUS outcome measure?
A: Our research confirmed that the FOCUS measures change well for children between 18 months and 72 months of age. The research indicated that the FOCUS was less sensitive to change for children younger than 18 months of age. The FOCUS has been shown to measure change for children with dysarthria who are up to 7 years of age. More research is needed to determine the sensitivity of the FOCUS with older children.