A Mixed Methods Analysis of Pediatric Voice Therapy - Voice disorders occur in 6–17% of children, resulting in dysphonia (i.e., altered vocal quality), which has significant negative health, social, emotional, and educational consequences if left untreated. Voice therapy is the gold-standard treatment for children with vocal fold nodules, the most commonpediatric voice disorder. Most children diagnosed with vocal fold nodules receive therapy at one of the few specialized pediatric voice clinics in the country. Families that do not have access to these specialized clinics may turn to the school system for therapy, however, speech-language pathologists (SLPs) in the school system self-report lower competency levels and lack of knowledge and comfort in treating pediatric voice. Therefore, the scarcity of specialized pediatric voice clinics has created a significant health equity issue as children unable to attend specialized pediatric voice clinics due to lack of financial or physical access will be significantly disadvantaged compared to their more affluent and well-situated peers. To address this critical gap, the long-term goal of this research program is to create training programs and materials for SLPs who practice outside of specialized clinics (e.g., the schools), with materials based on the best practice derived from expert pediatric voice clinicians. This research program is designed to address multiple priority areas of the NIDCD, including promoting health equity (Theme 4) and scientific advancement (Theme 5). Outcomes will also address the NIH-Wide Crosscutting Priority of reducing health disparities. The current study will identify key themes of expert pediatric voice therapy, a critical first step to improving the knowledge and skills about pediatric voice therapy for SLPs in all settings. Outcomes from this work will identify best practices in expert pediatric voice therapy, providing an essential foundation for a subsequent R01 to develop a training program for treating pediatric voice. In the current work, pediatric voice therapy sessions will be videotaped without interference at two top, high-volume pediatric voice centers (Boston Children’s Hospital, Cincinnati Children’s Hospital Medical Center). Video recordings will be analyzed offline using a two-phase explanatory sequential mixed method design, with the quantitative analysis phase followed by a qualitative analysis phase. Aim 1 will use qualitative content analysis to examine communication methods (relational, instrumental, affective) based on interpersonal communication theory. Aims 2 and 3 will be data-driven thematic analyses of how experts structure therapy sessions, such as the task order or how to incorporate games and breaks (Aim 2) and how experts implement frequently used therapy tasks (Aim 3). The research will be completed at Temple University (R1 university), which maintains a robust research environment with exceptional dedication and support to early-career faculty. This Early Career Stephen I. Katz R01 submission represents two clear changes in direction for the PI, a change in methodology (mixed methods design, qualitative analyses) and a change in population (expert pediatric voice clinicians).
