Speech Pathology and Audiology - Collected Works

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    Hearing handicap and quality of life: Reports by cochlear implantees and their frequent communication partners
    (Speech Pathology Association of Australia Ltd., 2001-05) Williams, Natalie ; Lind, Christopher ; Russell, Alison ; Swiderski, Nina
    Questionnaires concerning communication, hearing handicap and quality of life were posted to all 55 adult cochlear implantees known to be resident in South Australia. Parallel questionnaires were included for completion by a chosen frequent communication partner. This interim analysis focuses on replies from 34/55 (61.8%) of recipients currently received on two scales included in the questionnnaire; the Hearing Handicap Inventory for the Elderly (HHIE - Ventry & Weinstein, 1982), and the SF-36 (Ware, Snow, Kosinski & Gandek, 1993). The main results indicate that: (a) implantees and their frequent communication partners substantially agree in their assessment of the hearing handicap remaining post-implantation, and (b) implantees’ ratings of aspects of quality of life are similar to those of the general population in South Australia. These results indicate both the complimentary and confirmatory nature of these two scales. Implications for assessment and intervention for this population are discussed in light of these findings.
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    Auditory-visual speech perception: The effect of visual acuity in older people
    (Australian Academic Press, 2004-03) Hickson, Louise ; Hollins, Manda ; Lind, Christopher ; Worrall, Linda ; Lovie-Kitchin, Jan E
    This study aimed to investigate the benefit gained by older people in auditory-visual speech perception compared to auditory-only perception and to investigate the correlation between visual acuity and benefit gained. A total of 77 community-based older people participated in the study. Pure-tone audiometry showed that 36% had normal hearing, 40% had a mild hearing loss and the remainder (23%) had a moderate or greater loss. Objective easurements of corrected distance and near visual acuities were obtained using the Bailey-Lovie logMAR distance and near visual acuity tests. According to the criteria used in the present study, 34% had some distance vision impairment and 9% had some near vision impairment. The benefit gained in auditory-visual speech perception was determined by comparing auditory-only and auditory-visual performance on the Bamford-Kowal-Bench Australian Version Speech reading Test. An average visual benefit of 28.8% was achieved by the participants, and, for the vast majority of participants (86%), the benefit gained was statistically significant. A significant correlation was not found between either distance or near visual acuity and benefit gained in auditory-visual speech perception. The implications of these findings are that it is important for audiologists to recommend the use of lipreading to older clients, irrespective of their visual impairment, as the majority will gain significant benefit from the use of visual cues.
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    Conversation Repair and Acquired Hearing Impairment: A Preliminary Quantitative Clinical Study
    (Australian Academic Press, 2004-04) Lind, Christopher ; Hickson, L
    This report provides a quantitative summary of the initial findings in a series of investigations into the validity and reliability of repair behaviour recorded in free conversation in clinical settings between adults who have acquired hearing impairments (HIs) and their frequent communication partners (FCPs). Seven adults who have severe or greater acquired HIs (and who had subsequently been either fitted with hearing aids or undergone cochlear implanta-tion) were audio-recorded undertaking a 20-minute free conversation in a quiet clinical setting with their chosen FCP. Transcriptions of the conversations were analysed for the occurrence of repair sequences following the Conversation Analysis (CA) model. A total of 735 completed repair sequences were identi-fied across the seven conversations, the majority occurring within the same turn as the trouble source. No difference was noted in the frequency with which all but one trajectory was initiated by either the HI or FCP participants. Repairs initiated by the HI participant and repaired by the FCP in response to a trouble source in a previous turn by the FCP occurred significantly more often than the same sequence initiated by the FCPs. The results empha-sise the usefulness of framing repair activity arising from acquired HI in the broader conversational act of repairing and the CA model.
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    Engaging educators and students in the national roll-out of a new assessment tool (COMPASS).
    (University of South Australia, 2008) McAllister, Sue Margery ; Ferguson, Alison ; Lincoln, Michelle ; McAllister, Lindy
    This paper presents key results of an evaluation of a project (funded by ALTC), that led the integration of a newly developed competency based assessment tool (COMPASS™) within all 13 speech pathology education programs nationally. As part of the roll-out process, workshops were provided to close to 1,000 speech pathology clinical educators and students were introduced to the new tool through their lectures and tutorials. In order to provide formative feedback in the early stages of the project (end 2006 – early 2007); a questionnaire (designed to elicit both quantitative and qualitative data) was used following the first 6 workshops (214 educators) and after the first lectures to students at 2 universities (145 students). Most educators (95-97%) and students (74-85%) reported understanding the main concepts that inform key components of COMPASSTM (behavioural descriptors, generic competencies, and use of the Visual Analogue Scale). Qualitative feedback indicated a need for further support in relation to understanding the need for direct observation and the use of the Visual Analogue Scale. Toward the completion of the project (end 2007 – early 2008), a similar questionnaire was distributed to clinical educators (33 respondents) and to students in 3 universities (76 respondents). Results continued to be positive for understanding of main concepts for educators (79-100%) and for students (75-92%). An important finding was the close similarity between educators and students in relation to their understandings about the tool, the areas in which they reported wanting more support/training, and the ways in which they would like to obtain further experience. The implications of these findings for the further embedding of the new assessment tool are discussed.
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    Engaging speech pathology students in design and validation of competency based assessment in the workplace.
    (University of South Australia, 2008) McAllister, Sue Margery ; Lincoln, Michelle ; Ferguson, Alison ; McAllister, Lindy
    In Australia, the discipline of speech pathology has been engaged in competency based education in a sustained manner for 15 years. Speech pathologists are university educated professionals who work in the health and education sectors, with people experiencing communication and/or swallowing difficulties. Speech pathology programs have, from their inception, combined university and workplace based education (practicum) strategies. University courses are accredited by Speech Pathology Australia (SPA), so that their graduates are deemed ‘eligible’ for membership of SPA. This accreditation process has been guided by the CBOS Competency Based Occupational Standards for Speech Pathologists - Entry level (SPAA, 2001) (known as CBOS, pronounced cee-bos). The CBOS were developed through a national collaborative project (Dawson, 1993a, 1993b) and subsequently revised in 2001. CBOS identifies concepts and descriptions of professional competence, and makes statements about what level of performance is required for entry into practice (Ferguson, 2006).
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    Conversation Therapy: Interaction as Intervention
    (Sonova., 2009-10) Lind, Christopher
    This chapter presents an overview of the history, principles and clinical practice that might be labelled “Conversation Therapy” (henceforth, CT) in the context of aural rehabilitation (AR) for adults who have post-lingual hearing impairment (HI). Conversation is recog-nised as the major activity limitation/participation re-striction arising from HI and as such, the therapy, as out-lined in this chapter, is designed primarily to address the everyday conversation difficulties of adults who have HI. The focus on post-lingual HI implies that clients pres-ent with normal adult speech, language and conversa-tional abilities limited only by the reduction in ease of speech reception as a consequence of their HI. While the AR work outlined here is by no means limited to this population, it is designed with the view that the individ-ual had normal adult everyday spoken communication skills prior to the onset of their HI. The hallmarks of the clinical activities included in CT are: (a) their focus on interaction rather than on speech reception, (b) the incorporation of the full range of structural linguistic, interactional, environmental and interpersonal context cues, (c) the incorporation of units of speech (or more appropriately, “talk”) larger or longer than the syllable, word, phrase or sentence, (d) the use of tasks which can be designed with the client’s situation specific difficulties in mind and (e) the increased atten-tion paid to the role of the conversation partner in the resolution of conversational difficulties arising from the post-lingual HI. This chapter makes no claim that CT is a new ther-apy in AR, nor that it has been developed in a concerted or coordinated fashion. Rather, the term is applied retro-spectively, grouping certain existing therapy activities by their focus on conversational or interactional conse-quences of post-lingual HI, including therapies such as environmental and hearing tactics (Kaplan, Bally, & Garretson, 1985) as well as communication therapy (Er-ber, 1996, 2002; Erber, & Lind, 1994) and psychosocial intervention (Pedley, Giles, & Hogan, 2005).
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    Conversation Analysis of Repair in Interaction with Adults who Have Acquired HI
    (Sonova., 2009-10) Lind, Christopher ; Okell, Elise ; Golab, Jenna
    This chapter presents a summary of some recent re-search which has been undertaken to address the pat-terns of conversational behaviour in interaction involv-ing adults who have post-lingual hearing impairment (HI). The purpose behind this research is to develop a clinical assessment and intervention protocol for assist-ing HI adults and their conversation partners in reduc-ing the impact of conversation breakdown and its repair in everyday talk. Lind (this volume) lists various conversational be-haviours which arise in the conversation of HI adults and which have been identified by the authors as being mal-adaptive . Each of these behaviours may evolve to be a genuine target for intervention. However, at this point, the patterns of most of these behaviours as they are in-fluenced by one person’s HI are not yet well enough un-derstood nor are they yet clearly distinguished from the same behaviours as they occur in conversations not in-fluenced by HI. Until evidence of their patterns of occur-rence and their sequential consequences is established they cannot readily be translated into goals for assess-ment or intervention. Amongst these behaviours, conversation repair has been the most commonly identified therapy target, for two reasons. First, it is the only one of these behaviours that can be identified a priori as a problem for conversa-tional fluency. Repair is by its very nature the result of a breakdown in mutual understanding in the conversa-tion. Participants’ attempts to resolve the breakdown inhe immediate environment in which it occurred speaks to the importance to the talkers of re-instating mutual understanding. Second, there is now a growing body of research that identifies the patterns of repair as they may be influenced by post-lingual HI. The common se-quential behaviours in one particular type of repair were outlined briefly in Lind (this volume). Two additional ex-amples are provided here also. This series of projects from our recent research has been designed as the early stages in an attempt to ad-dress the foundation issues in conversation-based ther-apy; a model of therapy in which clinical tasks directly address conversation difficulties arising as a result of one participant having a post-lingual hearing impair-ment. The studies have been designed to address key questions about the clinical patterns of repair behaviour, including: • Can we reliably sample conversation repair? • Is repair behaviour consistent over time? • Is repair influenced by intervention? and • Does repair in conversationally-oriented clinical tasks mirror repair in conversation sampling?
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    Issues in developing valid assessments of speech pathology students' performance in the workplace
    (Wiley, 2010) McAllister, Sue Margery ; Ferguson, Alison ; Lincoln, Michelle ; McAllister, Lindy
    Abstract Background Workplace based learning is a critical component of professional preparation in speech pathology. A validated assessment of this learning is seen to be ‘the gold standard’ but it is difficult to develop because of design and validation issues. These issues include the role and nature of judgement in assessment, challenges in measuring quality, and the relationship between assessment and learning. Valid assessment of workplace based performance needs to capture the development of competence over time and account for both occupation specific and generic competencies. Aims This paper reviews important conceptual issues in the design of valid and reliable workplace based assessments of competence including assessment content, process, impact on learning, measurement issues and validation strategies. The paper then goes on to share what has been learned about quality assessment and validation of a workplace based performance assessment using competency based ratings. The outcomes of a 4 year national development and validation of an assessment tool are described. Methods A literature review of issues in conceptualising, designing and validating workplace based assessments was conducted. Key factors to consider in the design of a new tool were identified and built into the cycle of design, trialling and data analysis in the validation stages of the development process. Main contribution This paper provides an accessible overview of factors to consider in the design and validation of workplace based assessment tools. It presents strategies used in the development and national validation of a tool COMPASS™, used in every speech pathology program in Australia, New Zealand and Singapore. The paper also describes Rasch analysis, a model based statistical approach which is useful for establishing validity and reliability of assessment tools. Conclusions Through careful attention to conceptual and design issues in the development and trialling of workplace based assessments, it has been possible to develop the world’s first valid and reliable national assessment tool for assessment of performance in speech pathology.
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    Adults’ Perceptions of Their Tinnitus and a Tinnitus Information Service
    (Australian Academic Press, 2010) Adams, Jennie ; Verrier, Emily ; Walsh, Megan ; Lind, Christopher
    The South Australian Government funds Tinnitus SA to provide advice and information to South Australians to assist in their understanding of tinni-tus and their decision making about tinnitus-related service provision. This qualitative study aimed to identify key motivations for adults seeking tinnitus advice, determine how those services are perceived, and provide insight into the help-seeking behaviour of those who experience tinni-tus. Participants in this study were recruited from Tinnitus SA’s attendance lists for their community information sessions held in 2008 and 2009. Of the 60 people contacted, 13 adults agreed to particpate in the semistructured interviews. Interviews, lasting approximately 45 minutes focused on interviewees’ perceptions of their tinnitus prior to attending the Tinnitus SA information session, their response to the information session itself, and their perceptions and actions following the information session. Grounded theory was used as the guiding method-ology for analysis of the transcribed interview data. The themes that emerged during analysis of the interviews fell into two broad descriptive categories: Empowerment through information and education; and If you can’t cure me I’ll cope. Together these categories led to the overarching theme of participants’ responses: ‘I don’t need help, but I’d like more information’. Further analy-sis revealed that the Tinnitus SA community sessions were the primary source of information for the majority of these participants and there was a high level of satisfaction with these sessions by contrast to other information sources.
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    Becoming familiar with competency based student assessment: An evaluation of workshop outcomes
    (Taylor & Francis, 2010) McAllister, Sue Margery ; Ferguson, Alison ; Lincoln, Michelle ; McAllister, Lindy ; Owen, Susanne
    The identification and specification of competency based standards in speech language pathology has provided practitioners, educators, employers and government regulators with information and guidance. This paper reports the outcomes of workshops that provided familiarisation with the new competency based assessment tool, COMPASS®, which was introduced for the assessment of speech-language pathology (SLP) students across all 13 SLP professional preparation programs in Australia during 2007. An anonymous evaluation was administered before and after the first 8 familiarisation workshops held nationally, involving 240 clinical educators. Quantitative data were analysed descriptively, and qualitative data were entered into NVivo qualitative analysis software for content analysis. Post workshop, results indicated partial or full uptake of the main concepts involved in the new approach to assessment. Least uptake was observed for the need for direct observation of competence in workplace performance. Qualitatively, post workshop, formative assessment was more apparent within student goals formulated in response to a hypothetical scenario. A possible contributor to this outcome is suggested to be the alignment between the tool and the professional community of practice, due to the collaborative process of its development. Research into the longer term impact of the new assessment in the context of everyday practice is suggested.
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    Self-Reported Hearing Handicap and Mental Health in Australia: Some Preliminary Findings
    (Australian Academic Press, 2010-11) Veale, Holly ; Gill, Laura ; Ng, Swee Guan ; Lind, Christopher ; Bond, Malcolm James
    It has long been suggested that the consequences of adult hearing impairment (HI) include stress, anxiety and depression, yet relatively little formal assessment of mental health status amongst adult Australians who have acquired HI has been reported. This questionnaire- based study investigated the self-reported hearing handicap and mental health characteristics of a sample of 375 Australian adults with HI who were members of Better Hearing Australia (BHA) in six Australian states/territories. Participants completed two mental health questionnaires; the Kessler Psychological Distress Scale-10 (K-10; Kessler, Andrews, Colpe, & Hiripi, 2002) and the Depression- Anxiety-Stress Scale (DASS; Lovibond & Lovibond, 1995) as well as the short version of the Hearing Handicap Inventory for Adults — Screening Version (HHIA-S; Newman, Weinstein, Jacobson, & Hug, 1990). No difference was found in the prevalence of psychological distress amongst participants compared to that of the Australian adult population. It was noted, however, that increased severity of self-reported hearing handicap was associated with higher levels of self-perceived psychological distress. In turn, high or very high levels of psychological distress measured on the K-10 were correlated with depressive states more than with stress or anxiety ratings on the DASS. The results highlighted the need to incorporate a combination of questionnaire-based measures in evaluating self-reported mental health and hearing handicap.
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    Attendees’ Perceptions of, Motivation for and Outcomes, Following an Adult Group Aural Rehabilitation Program
    (Australian Academic Press, 2010-11) Golder, Fleur ; Walsh, Erin ; Buchanan, Angus ; Lind, Christopher
    The aim of this grounded theory (GT) study was to gain insight into adult participants’ perceptions of a group aural rehabilitation (AR) program. The partici-pant group for this in-depth interview-based study were 8 female and 2 male adults with acquired hearing losses who had completed an introductory group AR course conducted by South Australian organisation Hearing Solutions (now Guide Dogs of South Australia and Northern Territory Hearing Services) in the prior 12 months. Semistructured interviews were carried out and analysed using GT methodology. The core category (Empowerment through improved self-image) describes the overall main benefit the partici-pants reported from attending the course. Six descriptive categories were found that underpinned the core category: Improved understanding of communication strategies, Improved social relation-ships, Course satisfaction, Personal validation from social interaction, Decreased emotional isolation, and Improved self-confidence. An additional three descriptive categories were discovered that related to factors that motivated people to attend the course: Motivation for change, Hearing difficulties, and Negative self-perceptions of hearing loss. The current study provides a model for understanding how these factors may interrelate, and highlights the importance of motivation and group interaction in obtaining positive outcomes in AR
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    A systematic program of research regarding the assessment of speech-language pathology competencies
    (Informa UK, Ltd, 2011-08-16) McAllister, Sue Margery ; Lincoln, Michelle ; Ferguson, Alison ; McAllister, Lindy
    This paper explores the nature and development of competence in speech-language pathology and is informed by the development and validation of a competency-based assessment tool to assess Australian speech-language pathology students’ professional performance in the workplace (COMPASS®). Background is provided on speech-language pathology competency frameworks in Australia and a systematic program of research to validate this assessment tool. Findings relevant to understanding the nature and development of speech-language pathology competency are described. The domains of competence considered important for practice were found to extend beyond specific processes of professional practice to include generic competencies of Reasoning, Communication, Lifelong Learning, and Professionalism. The achievement of competency was identified as developmental, and clinical educators were found to validly and reliably identify seven levels of competency development. Competency may transfer across the scope of practice and marginal students’ performances were characterised by a high degree of variability. These findings are discussed in relation to the profession’s understanding of competency and speech-language pathology education, professional development and further research.
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    Checklist of parent Lidcombe Program administration
    (Speech Pathology Australia, 2012) Swift, Michelle Catherine ; O'Brian, Sue ; Onslow, Mark ; Packman, Ann
    This article outlines the development of a checklist to document parent and child behaviours when implementing Lidcombe Program treatment during structured conversations. We present item development and reliability testing and instructions for use by speech pathologists. Finally, we present two case studies to demonstrate use of the checklist to aid clinical decision-making during Lidcombe Program treatment.
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    Swallowing Neurorehabilitation: From the Research Laboratory to Routine Clinical Application
    (Elsevier, 2012-01-27) Doeltgen, Sebastian ; Huckabee, Maggie-Lee
    The recent application of neurostimulation techniques to enhance the understanding of swallowing neural plasticity has expanded the focus of rehabilitation research from manipulation of swallowing biomechanics to manipulation of underlying neural systems. Neuromodulatory strategies that promote the brain's ability to reorganize its neural connections have been shown to hold promising potential to aid the recovery of impaired swallowing function. These techniques include those applied to the brain through the intact skull, such as transcranial magnetic stimulation or transcranial direct current stimulation, or those applied to the sensorimotor system in the periphery, such as neuromuscular electrical stimulation. Recent research has demonstrated that each of these techniques, either by themselves or in combination with these and other treatments, can, under certain circumstances, modify the excitability of motor representations of muscles involved in swallowing. In some studies, experimentally induced plastic changes have been shown to have functional relevance for swallowing biomechanics. However, the transition of novel, neuromodulatory brain stimulation techniques from the research laboratory to routine clinical practice is accompanied by a number of ethical, organizational, and clinical implications that impact professions concerned with the treatment of swallowing rehabilitation. In this article, we provide a brief overview of the neuromodulatory strategies that may hold potential to aid the recovery of swallowing function, and raise a number of issues that we believe the clinical professions involved in the rehabilitation of swallowing disorders must confront as these novel brain stimulation techniques emerge into clinical practice.
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    Assessing the language skills of children from culturally and linguistically diverse backgrounds: The expressive vocabulary performance of Singaporean English-Mandarin bilingual preschoolers
    (Informa Healthcare, 2012-02-15) Teoh, Wei Qin ; Brebner, Christine Mary ; McCormack, Paul Francis
    Standardized language assessments such as the Clinical Evaluation of Language Fundamentals Pre-school 2 United Kingdom (CELF Preschool 2 UK) are often used in speech-language pathology clinics to determine if a child is at risk of language difficulties. Many of these assessments are designed and standardized for use with monolingual Standard English-speaking children. It is thus recommended that these assessments should only be used with the populations they were designed for; if not test bias might result. However, such tests are still selected and used in the clinics of many multicultural and multilinguistic communities (e.g., Singapore). This research aimed to explore the performance of 79 Singaporean English-Mandarin pre-school children on the Expressive Vocabulary (EV) sub-test of the CELF Preschool 2 UK and to determine if their performance on the EV sub-test accurately reflected their language abilities by comparing their performance on a local screening language assessment tool, the Singapore English Action Picture Test (SEAPT). Results showed that local children performed poorly as compared to their UK counterparts. Two plausible reasons for the findings are: (1) the sub-test elicited only a single measure in English which ignored the language abilities of these bilingual children in their second language; and (2) the presence of culturally and linguistically biased test items.
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    Twelve tips for supporting student learning in multidisciplinary clinical placements
    (Taylor & Francis, 2012-07-20) O'Keefe, Maree ; Burgess, Teresa ; McAllister, Sue Margery ; Stupans, Ieva
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    Assessment of student competency in a simulated speech-language pathology clinical placement
    (Taylor & Francis, 2013-08-30) Hill, Anne E. ; Davidson, Bronwyn J. ; McAllister, Sue Margery ; Wright, Judith ; Theodoros, Deborah G.
    Clinical education programs in speech-language pathology enable the transition of students’ knowledge and skills from the classroom to the workplace. Simulated clinical learning experiences provide an opportunity to address the competency development of novice students. This study reports on the validation of an assessment tool designed to evaluate speech-language pathology students’ performance in a simulated clinical placement. The Assessment of Foundation Clinical Skills (AFCS) was designed to link to concepts and content of COMPASS®: Competency Assessment in Speech Pathology, a validated assessment of performance in the workplace. It incorporates units and elements of competency relevant to the placement. The validity of the AFCS was statistically investigated using Rasch analysis. Participants were 18 clinical educators and 130 speech-language pathology students undertaking the placement. Preliminary results support the validity of the AFCS as an assessment of foundation clinical skills of students in this simulated clinical placement. All units of competency and the majority of elements were relevant and representative of these skills. The use of a visual analogue scale which included a pre-Novice level to rate students’ performance on units of competency was supported. This research provides guidance for development of quality assessments of performance in simulated placements.
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    Intake of thickened liquids by hospitalized adults with dysphagia after stroke
    (Informa Healthcare, 2013-09-05) Murray, Jo ; Miller, Michelle Deanne ; Doeltgen, Sebastian ; Scholten, Ingrid Maria
    There is widespread concern that individuals with dysphagia as a result of stroke do not drink enough fluids when they are prescribed thickened liquids. This paper details a retrospective audit of thickened liquid consumption of 69 individuals with dysphagia following stroke in acute and rehabilitation hospitals in Adelaide, South Australia. Hospitalized individuals with dysphagia following stroke drank a mean of 781 ml (SD = 507 ml) of prescribed thickened liquids per day, significantly less in the acute setting (M = 519 ml, SD = 305 ml) than in the rehabilitation setting (M = 1274 ml, SD = 442 ml) (t(67) = -8.34, p < .001). This daily intake of thickened liquids was lower than recommended standards of fluid intake for hospitalized adults. Fluid intake could be increased with definitive protocols for the provision and monitoring of consumption of thickened liquids, by offering more fluid via food or free water protocols or by routine use of non-oral supplementary routes. Future research into the effectiveness of such recommendations needs to evaluate not only the impact on fluid intake but also on health outcomes.
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    Impact of placement type on the development of clinical competency in speech–language pathology students
    (John Wiley & Sons, inc., 2013-11-01) Sheepway, Lyndal ; Lincoln, Michelle ; McAllister, Sue Margery
    Background: Speech language pathology students gain experience and clinical competency through clinical education placements. However, currently little empirical information exists regarding how competency develops. Existing research about the effectiveness of placement types and models in developing competency are generally descriptive and based on opinions and perceptions. The changing nature of education of speech language pathology students, diverse student cohorts, and the crisis in finding sufficient clinical education placements mean that establishing the most effective and efficient methods for developing clinical competency in students is needed. Aims: To gather empirical information regarding the development of competence in speech language pathology students, and to determine if growth of competency differs in groups of students completing placements which differ in terms of caseload, intensity and setting. Methods & Procedures: Participants were students in the third year of a four year undergraduate speech language pathology degree, who completed 3 clinical placements across the year and were assessed with the COMPASS® competency assessment tool. Competency development for the whole group across the three placements is described. Growth of competency in groups of students completing different placement types is compared. Interval level data generated from the students’ COMPASS® results were subjected to parametric statistical analyses. Outcomes and Results: The whole group of students increased significantly in competency from placement to placement across different placement settings, intensities and client age groups. Groups completing child placements achieved significantly higher growth in competency when compared to competency growth of students completing adult placements. Growth of competency was not significantly different for students experiencing different intensity of placements, or different placement settings. Conclusions and Implications: These results confirm that the competency of speech language pathology students develops across three clinical placements over a one year period regardless of placement type or context, indicating that there may be transfer of learning between placements types. Further research investigating patterns of competency development in speech language pathology students is warranted to ensure that assumptions used to design clinical learning opportunities are based on valid evidence.