Presented by: Carol Lorden-Lancelin & Pam Williams
Framework of NOMS:
More than 98,000 speech-language pathologists, audiologists and speech, language and hearing scientists are members of The American Speech Language Hearing Association (ASHA 2000). In response to members requests for outcomes information to prove the effectiveness of speech and language services ASHA formed a Task Force on Treatment Outcomes in October of 1993. After a thorough review of existing databases, the Task Force found that there was no data on the value of services we as professionals were expected to provide. In 1994-1996 the Task Force began the development of a national database for the professions. In continuation of these efforts ASHA formed the National Center for Treatment Effectiveness in Communication Disorders (NCTECD) to coordinate all outcomes and efficacy work for the Association. In 1997, NCTED focused their efforts on the development of a National Outcomes Measurement System (NOMS) for speech-language pathologists and audiologists working with preschool and school-aged students. Data collection for the adult health care component began in 1998 with the Pre-Kindergarten component following in early 1999. In constructing and interpreting valid outcome measurements three fundamental concepts must be covered: the operational definition (what is to be measured), the evidence needed to support the claim (data analysis), and the pragmatic value (functional importance) of the outcome (Frattali, C. 1998a). The key to NOMS is the use of ASHA's Functional Communication Measures (FCMs). FCMs are a series of disorder-specific, seven-point rating scales designed to describe the change in an individual's functional communication ability over time. Based on a patient's treatment plan, FCM's are chosen and scored by a certified SLP on admission and again at discharge to depict the amount of change in communication and/or swallowing abilities after speech and language intervention. By examining the scores from admission and discharge, clinicians can assess the amount of change and thus the benefits of treatment. There are fact sheets that provide a snapshot of data collected in different treatment settings, such as Adult Noms Skilled Nursing, Acute Care Settings and Outpatient Setting. Other areas include K-6 Schools and Pre-Kindergarten. Our ASHA NOMS Resource Center offers an in-depth look and analysis of all data collected however, membership is required (NOMS Data).
Purpose of NOMS:
The purpose of NOMS is to collect aggregated national outcomes data from speech-language pathologists and audiologists working with adults and children in both school and health care settings. This is one of the most challenging tasks facing speech-language pathologists today. Simply stated, SLPs and Audiologists need to determine whether or not our treatment actually works. This need was apparent across the broader spectrum of the health-related professions, in part due to the increasingly restrictive requirements of insurance companies and other third-party payers (e.g., Frattali, 1998a), and in part due to clients' increasing awareness of different treatment options. In addition to recent changes resulting from the reauthorization of IDEA, school-based administrators are experiencing shrinking educational budgets, reallocation of educational funds, increased enrollments in special education, and the need to prioritize service delivery. Even without the demands of payers and consumers, speech language pathologists needed to demonstrate that our treatments achieve their goals for ethical and professional reasons. This will also facilitate information in caseload planning and management as well as with meeting state and federal guidelines.
" Over 3,400 clinicians working across the health care continuum or in school settings are currently participating in ASHA's data collection efforts in one or more of its three speech-language pathology components; Adults in Health Care, K-6 Schools, and Pre-Kindergarten Health/Schools."
Link to: www.professional.asha.resources/noms/index.cfm
Therapists have been faced with increasing caseloads, paperwork demands, and student populations with more significant disabilities. All therapists needed a new tool that would improve the quality of services for their students and address the needs of a changing and diverse caseload. NOMS data has been the answer for clinicians who participate in the program. Therapists can use NOMS date to make predictions about a student's future progress. It can show parents and teachers where students have been, where they are functioning at the present time and where they are going in each communication area. NOMS has been a valuable asset to practices everywhere and has shown that ASHA does care about their speech/language pathologists.
NOMS Data Shows:
1. Functional outcomes that are seen at the end of the SLP treatment.
2. Feedback from classroom teachers in a very positive way.
3. Issues about caseload size.
4. Tells when group treatment is not effective.
5. Tells when individual treatment is needed.
6. How frequency and intensity affects outcome.
Taken from ASHA Leader, 9/11/2001, Vol. 6 Issue 16, p26. 1p, 2 graphs, 1c
Link to: http://search.epnet.com/direct.asp
Benefits to the Speech-Language Pathologist
1. Facilitate caseload planning and management
2. Support writing functional IEP goals.
3. Establish entrance and dismissal criteria for different communication disorders.
4. Project the average amount of time required to resolve communication disorders at different grade levels.
5. Determine the amount of progress that might be expected.
6. Determine preferred type and model of service delivery for different communication disorders at different grade levels.
7. Improve the quality of the speech and language services.
What Does a Speech-Language Pathologist need to do to Participate in NOMS?
1. Make a commitment to report outcomes data as part of other record keeping activities.
2. Submit data to ASHA.
3. Encourage colleagues to make a commitment to data collection.
4. Recommend that the school system become involved in NOMS data collection.
What Can Participants in NOMS Expect From ASHA?
1. Self-study training program, preferred method of data collection, and technical assistance.
2. Data reports for your school system
3. National data for benchmarking.
Taken from: ASHA. (July 1999). National Outcomes Measurement Systems (NOMS): Gaining the Support of Your Staff and Administration: Schools
NOMS data are providing evidence about the impact of our services and arming members of ASHA with the tools needed to answer CRITICAL QUESTIONS about treatment expectations such as:
1. On average, how many sessions are needed to treat an adult or child with a specific diagnosis?
2. On average, how much gain will an adult or child demonstrate during a given time period?
3. How long will it take an individual to get from a non-functional skill level to a functional level?
4. What is the most effective service delivery model?
5. What is the ideal caseload size for an SLP working in a school setting?
6. How satisfied are consumers with the services provided?
Taken from: What You
Don't Know Can't Hurt You.
ASHA Leader, 9/11/2001, Vol. 6 Issue 16, p23, 1p
link to: http://search.epnet.com/direct.asp
How can you as a clinician become involved in NOMS?
In order to participate in NOMS data collection, you must first gain the support of your staff director or manager that agrees to serve as a liaison between your organization and ASHA. All of your organization's SLP's must be members of ASHA. Secondly, complete the attached Subscriber Registration Form and two letters of Agreement and submit to ASHA. Thirdly, receive the training materials and become registered NOMS users.
Participants say:
" We use NOMS data to show our local United Way panels and boards the need for our services, and prove the benefits that have been received by the patients and their families. Prior to the NOMS Pre-Kindergarten project, speech departments used data provided by ASHA from the Annual Report."
Source: ASHA Leader, 9/11/2001, Vol. 6 Issue 16, p25, 1p, 2 graphs, 1c
" I was able to show the effectiveness of treating various voice disorders through speech-language pathology intervention."
Title: Adult NOMS
Source: ASHA Leader, 9/11/2001, Vol. 6 Issue 16, p24, 1p, 2 graphs, 1c