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OIC: The Ca

m b o d i a

Pro

j e ct

JUNE 2015

Speech Therapy Pilot


Program Evaluation

Ms. Anna Rogers


Dr. Chyrisse Heine

This report is based on research funded by a Speech Pathology Australia grant.


Research conducted and report prepared for OIC: The Cambodia Project and Speech Pathology Australia
by Ms. Anna Rogers and Dr. Chyrisse Heine1,2
Email: hello@oiccambodia.org
1 OIC: The Cambodia Project
2 La Trobe University

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Table of contents
Acknowledgements ............................................................................................................... 4
List of Acronyms ...................................................................................................................... 5
Overview ................................................................................................................................. 7
I. Introduction ......................................................................................................................... 12
II. Background, Context & Definitions ............................................................................... 14
2.1 Cambodia and the absence of speech therapy ........................................................ 14
2.2 A new baby ............................................................................................................ 16
2.3 Pilot training ........................................................................................................... 17
III. Scope & Methodology ..................................................................................................... 20
IV. Findings ............................................................................................................................ 22
4.1 Developing and applying knowledge ....................................................................... 22
4.2 Nurturing organisational relationships .................................................................. 26
4.3 Engaging families and the wider community .......................................................... 27
4.4 Initial outcomes ....................................................................................................... 30
V. Recommendations ........................................................................................................... 34
VI. Conclusion ........................................................................................................................ 41
References ................................................................................................................................ 42
Appendices ......................................................................................................................... 43

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Acknowledgements
This research would not have been possible without the
support of Speech Pathology Australia. We thank them for
their generosity.
We would also like to acknowledge the support of Mr. Yeang
Bun Eang, the Executive Director of CABDICO as well as all
CABDICO staff who are always helpful, engaged and eager to
participate in programs of this nature.
We are indebted to all our volunteers who have contributed
time, effort and resources in such a generous and passionate
way.
Finally, we would like to thank the many children and their
families for welcoming us into their homes, talking to us
about their experiences and participating in this work so
enthusiastically.
Note: Permission to conduct this research was provided to Dr.
Chyrisse Heine by the National Ethics Committee for Health
Research, Cambodia (number 182 NECHR).

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List of Acronyms
CABDICO

Capacity Building for Disability Cooperation

CCAMH

Centre for Child and Adolescent Mental Health

CBR

Community Based Rehabilitation

CDO

Community Development Officer

CP

Cerebral Palsy

CRO

Community Rehabilitation Officer

DW

Disability Worker

JCU

James Cook University

MSC

Most Significant Change

NGO

Non-Governmental Organisation

ODM

Orthophonistes du Monde

PC

Project Coordinator

ST

Speech Therapy

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Overview
Background, scope and methodology
This report assesses the outcomes of pilot training
in basic speech therapy skills for Cambodian
disability workers. Conducted over eight months
in 2014, this training program is the first pilot
program to be comprehensively evaluated in
Cambodia. While the impact cannot be fully
assessed due to the short time frame and lack
of a comparable program, pilot training proved
effective in increasing disability workers basic
speech therapy skills and knowledge, having a
community reach of approximately one hundred
children (who consult the disability workers for
ongoing management).
OIC: The Cambodia Project was established to
bring this pilot into fruition, partnering with
Capacity Building for Disability Cooperation
(CABDICO), a Cambodian non-governmental
organisation supporting the empowerment of
Cambodian people with disabilities.
The nature and prevalence of disabilities in
Cambodia is poorly understood, yet recent
research by Handicap International indicates
that approximately 10.06% of Cambodian
children have disabilities, and treatment needs
are near 100% for those with moderate or worse
disabilities. Pilot training aimed to broaden
disability workers skill set to address basic speech
therapy needs, complementing and supporting
existing community based rehabilitation efforts.
OIC facilitated three training programs led
by three different organisations willing to
volunteer training services. Topics ranged
from fundamentals of communication and
swallowing disabilities to socialisation and
language development techniques (see Table
1). All training sessions covered much needed
anatomical and theoretical knowledge, and the
third session encouraged trainees to apply their
learning through site visits, role play, and other

applied activities. OIC also conducted a workshop


with parents and teachers to raise awareness of
basic speech therapy treatment and provide basic
language stimulation techniques.
This evaluations objectives were to:
1. Determine the impact of the speech therapy
training program in regards to:
Participants knowledge of speech therapy
Participants ability to provide speech
therapy interventions
The communication and swallowing
outcomes of children with disabilities
who are currently receiving services from
CABDICO
2. Identify any barriers faced by participants in
implementing speech therapy interventions
3. Determine the sustainability of the training
including cultural sensitivity, training
methodology and appropriateness of content
4. Provide recommendations that will guide the
content and format of future speech therapy
training programs, including a university
curriculum.
While data is too insufficient to rigorously assess
the communication and swallowing outcomes
for children with disabilities, this evaluation did
assess questionnaires from trainees and families to
determine initial training outcomes. Focus groups
and interviews with disability workers also delved
into the appropriateness and effectiveness of
training. The evaluation also trained CABDICO
disability workers to interview families they
work with to shed light on communication and
swallowing outcomes these families witnessed
and value.

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Findings
Developing and applying knowledge
Trainees highly valued the training they received,
particularly in:
Effective treatment of swallowing difficulties
Basic speech therapy principles
Communication disabilities
Pronunciation difficulties.
Trainees highlighted that pilot training increased
their knowledge, skills, and confidence in treating
speech therapy needs. All trainees expressed a
desire for further training, particularly requesting
further training in:
Developing and utilising games and
activities in their work
Pronunciation difficulties
Problem identification (diagnosis of speech
therapy difficulty).
Although trainees benefited from training, they
noted that training did not provide enough
opportunity to practice learnt skills with their
clientele on site or provide enough time with a
professional resource person afterward to consult.
Trainees did however feel confident in
implementing techniques through tools such as
games and phonetic sound tables. Trainees felt
less confident applying and transferring their
new knowledge to families through specific and
measurable goals, particularly for children with
severe cognitive disabilities. Without a training
guideline or an overarching framework, trainees
lacked confidence regarding their abilities which
lead to requests for additional training programs.
Nurturing organisational relationships
The pilot succeeded largely through the strong
established trust between OIC and CABDICO staff.
This trust mitigated the confusion and uncertainty
created by a lack of pilot framework. Nevertheless,
CABDICOs community based rehabilitation

workers felt that new OIC staff that were brought


into the project, while potentially helpful, did not
get the realities or needs of CABDICOs practice.
Both OIC and CABDICO staff highlighted the
lack of communication between staff members as
an impediment to effective pilot implementation.
OIC will need to invest dedicated time into interorganisation communication and rapport in order
to successfully manage partnerships with local
external organisations.
Engaging families and wider communities
Families are critical to successful speech therapy
treatment outcomes, particularly in a community
based rehabilitation setting where resources are
low. Community based rehabilitation operates
under the principle that, without a dedicated
therapist who can regularly provide treatment,
disability workers train families on replicating
therapy in the home setting. As disability workers
highlighted, families spend the most time with a
child and therefore knowledge transfer to families
is crucial. While CABDICOs disability workers
found most families helpful and supportive,
some families did not trust or make time for basic
speech therapy services. Families often invest
large amounts of time and money into traditional
healers or other treatments that prove fruitless,
and knowledge regarding speech therapy is
scant. Moreover, most of the families with whom
CABDICO works grapple with poverty, leaving
them limited time for treatment and limited
capacity to provide their child with recommended
food and fluid requirements to meet their
nutritional and swallowing impairment needs.
These issues create significant barriers to disability
workers treatment. Nevertheless, CABDICO
disability workers noted their strong relationships
in rural communities as an asset in overcoming
these barriers and recommend that OIC conduct
community workshops to raise awareness of
speech therapy.

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Initial outcomes
Outcomes observed four months after the third
training session only indicate short-term impacts
of the pilot project. While an assessment later on
will provide more insights, the projects first year
has generated several key changes for disability
workers and children with disabilities.
Outcomes for disability workers
All trainees reported that they gained crucial
knowledge, especially in communication
disabilities, pronunciation difficulties and
treating swallowing disabilities. CABDICO run
focus groups noted that training improved their
staffs relationships with families and built their
confidence to identify and treat communication
and swallowing issues. They also identified
significant improvements in their ability to
identify, diagnose and address speech therapy
needs.
Outcomes for families
Treatment documentation indicated that some
children have begun attending school or making

friends since basic speech therapy treatment began.


However, gaps in treatment documentation made
it difficult to gather a clear and consistent picture
of outcomes. However, questionnaires completed
by 19 families in January (pre-treatment) and May
(mid-treatment) 2014 demonstrate a dramatic
increase in families ability to understand their
children. For example, the number of children who
could communicate with their family most of the
time increased from 4/19 (21%) to 16/19 (84%).
During evaluation research, the 13 selected families
reported stories of the most significant changes in
family life since basic speech therapy treatment
began. Among the many changes families
identified, nine reported significant improvements
in swallowing, seven reported much clearer
speaking, about half noted increased family
happiness as a result of better communication and
about half noted that they have more time for other
tasks as their child becomes more independent.

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Recommendations
Create a clear training framework
A clear training framework will reassure disability
workers about their progress and encourage
confidence. It will also help disability workers
and their managers understand the demands,
expectations and opportunities training entails.
Consider a long series of short training sessions
Multiple training sessions are necessary to develop
and effectively apply sufficient knowledge and
skills. This evaluation recommends a hub and
spoke model, whereby a professional speech
therapy trainer/mentor (hub) delivers a long
series of short workshops and mentoring, dividing
their time across several different groups in
different areas (spokes). This will balance the
need for rigorous training and the constraints of
resources and time.
Use pilot feedback to create grounded curriculum
Trainees have specific knowledge of implementing
speech therapy training in culturally-appropriate
ways. Prior trainees should be involved in
developing future curriculum.
Develop the knowledge and attributes disability
workers need
Feedback from all trainees demonstrated that the
speech therapy topics disability workers need
instruction in the most are:







Communication targets
Swallowing techniques
Resource development
Pronunciation and voice techniques
Setting and monitoring goals
Transferring knowledge to families
Managing family expectations, and
Treating children with severe disabilities.

CABDICO focus groups also highlighted key


personal characteristics that disability workers
must develop for effective speech therapy
treatment, including:

Patience
Flexibility
Gentleness
Motivation, and
Enjoyment of work.

Disability workers and qualified speech therapists


assisting OIC noted that these personal skills
can be partially developed though modelling
behaviour and role play.
Train through action, practice, tools, and bodies
Role play and resource development allowed
trainees to apply their learning and build their
confidence. In addition, basic anatomy and
functioning are often not a part of disability
workers education, and the significant training
time devoted to basic anatomy, the larynx, and
its voice projection function, was a new and
enriching practice.
Emphasise developing and documenting goals
CABDICO disability workers reported that they
do not feel confident creating and assessing goals.
Managing family expectations and developing
SMART (Specific, Measurable, Achievable,
Relevant, and Time-Bound) goals requires more
thorough documentation and, most crucially,
professional mentoring.
Provide professional and peer mentors
Disability workers need ongoing professional
mentoring to develop speech therapy skills. In
addition, peer support networks would effectively
share learning resources and support among
former and new trainees.
Build wider community awareness
Community education should be a key component
of OIC. Lack of community awareness about the
nature and value of speech therapy is a major
barrier to successful treatment.

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Dream of a common language


This evaluation recommends that OIC prioritise
Khmer speech therapy language development as a
core component of pilot expansion. Better Khmer
speech therapy resources will likely improve
disability workers confidence and ability to
transfer basic speech therapy practice to families.
In addition, crucial documentation of treatment
and project implementation is burdensome without
a standard Khmer speech therapy language and set
of abbreviations. This evaluation also recommends
that OIC consistently use the same professional,
health literate translator as much as possible to
make training and monitoring more effective.

and ultimately provide minimal benefit to OIC.


Organisationally, OIC needs administrative
and project management support as much as
professional speech therapy support. These needs
would be best addressed by bringing in more local
staff.
Be mindful of context and relationships when
expanding and scaling up
Much of the pilots successes depended on the
strong relationship that was built between OIC
and CABDICO staff. Moreover, the outcomes of
the pilot are not generalisable across children with
disabilities in Cambodia.

Monitor for success

Account for training costs

While disability workers generally monitor their


work, much more thorough documentation from
trainees and OIC is necessary to effectively monitor
outcomes. Little is known about Cambodian
children with disabilities, and OIC can increase
national understanding of disability through
thorough monitoring including, capturing gender
disaggregated data and being aware of the needs
of the childs primary caregiver. Some of OICs
data sets were well-collected but not appropriately
organised or analysed, missing the opportunity to
learn from these good data sets.

OIC made an ethical decision to deliver all three


training sessions free of charge. While this prevents
marginalisation and fosters good relationships,
OICs financial stability could be significantly
strained if the expanded training program
remains free of charge. Charging a modest
training fee, using a sliding scale that accounts for
organisational budgets, may appropriately balance
these factors.

Keep staff roles clear and bounded


Better boundaries and shared understanding of
roles will increase the projects efficiency, prevent
partner organisation confusion and mitigate the
constraints of staff taking on more responsibilities
than they can effectively manage.
Focus on volunteers and staff who can contribute
to the biggest needs
Foreign volunteers, especially short-term
volunteers, may not understand cultural context

Maintain adaptability
OICs ability to adapt throughout pilot
implementation without constraining donor
requirements allowed it to make the most of its
limited resources. An expanded donor portfolio
would bring much needed financial support,
however, OIC should aim to maintain its flexibility.
This can be achieved through a donor that
understands the ever changing nature of piloting
new work and is open to evaluation methods that
go beyond the traditional rigidity of counting
numbers. An evaluation method that prioritises
and rewards learning would be far more beneficial.

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1 Introduction
This evaluation was initiated in February 2015,
only 13 months after the pilot speech therapy
training started, and four months after the pilot
training concluded. In that time, 19 disability
workers and hospital staff have used the basic
speech therapy skills they learned to support
children with communication and swallowing
disabilities. Speech therapy is a long-term process.
Nevertheless, after only months of basic speech
therapy services, children who participated in the
pilot program are better able to communicate with
the world around them, developing new abilities
to express themselves to their families, enrol in
school or make friends for the first time.
OIC aims to build the capacity of Cambodian
disability workers to identify and treat
communication and swallowing disabilities. By
supporting Cambodian community based speech
therapy practices, children can communicate better
and communities can understand them better and
be awakened to the possibilities for children with
communication and swallowing disabilities to lead
fuller and happier lives.
These training and treatment aims are interlinked
yet are different processes. The speech therapy
pilot program aimed to build basic speech therapy
capacity for Cambodian disability workers.
Therefore, this evaluation focuses on training
processes and outcomes. The evaluation considers
the effects of this training for children with
disabilities, their families, and wider Cambodian
communities to the extent possible at this early
stage.

Speech therapy is an entirely new practice in


Cambodia. While trained disability workers
are tracking changes in childrens speaking,
swallowing and use of non-verbal communication,
verified and Cambodia specific measures do not
yet exist to assess outcomes in the Cambodian
context. Therefore, in addition to analysing client
records and parent questionnaires, this evaluation
also sought stories of change from 13 families
currently engaged in basic speech therapy for their
child. These families were invited to identify and
explain any changes they deem important since
basic speech therapy treatment began. Disability
workers collected these stories and reported them
back to the evaluators.
Families highlighted changes in their childs
ability to communicate and to swallow food safely,
which in turn led to the childs increased health,
schooling, and/or social capacity. For example,
one mother of a 13 year old boy with cerebral
palsy reported that: The significant change is he can
speak in a better way and other people around him
understand his words. So he has more new friends.
Better communication and swallowing also
increased families understanding and happiness,
and parents were better able to do other tasks as
children became more independent.
These family identified stories of change appear
throughout this report to connect this evaluation
of pilot training to the outcomes families observe
and value.

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He can speak the words he heard. He stopped


coughing when eating food. The significant change
is he can play with other children. For instance, he
can visit his neighbours alone because those people
understand his words. His mother hopes that one
day he can go to school.
- Mother of an eight year old boy with cerebral palsy, as reported by disability worker -

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2 Background,
context & definitions
2.1 Cambodia and the absence of speech therapy
The nature and prevalence of disabilities in
Cambodia is not well understood. Research about
Cambodians with disabilities is scant, and many
Cambodians are unaware or misinformed about
disabilities (Evans, et al, 2014). A study conducted
by Handicap International in 2012 identified the
prevalence of children with disabilities at 10.06% of
the population (ibid.). In stark contrast, households
in Cambodias 2008 census self-identified children
with disabilities at less than 1%. The most common
disabilities identified in the Handicap International
study were cognition and speech (ibid.). Several
physical and cognitive impairments can lead
to communication and swallowing disabilities,
including cerebral palsy and cleft lip and palate.
Broadly, speech therapy aims to evaluate and treat
communication and swallowing disabilities.
Early intervention for children with disabilities is
critical, as the earlier a child receives treatment,
the more effective treatment outcomes are (Paul
and Roth, 2011). As one-third of Cambodians are
under the age of 15 (Evans, et al, 2014), the effects
of late intervention or no intervention for children
with disabilities are likely to be far reaching and
substantial.
OIC: The Cambodia Project was established as part
of Capacity Building for Disability Cooperation
(CABDICO) in 2013 to develop a universally
available, locally-led speech therapy service
system in Cambodia. CABDICO is a Cambodian
non-governmental organisation (NGO) that
supports the empowerment of people with

disabilities in rural areas. Focusing in Siem Reap


and Kep provinces, CABDICO provides support
for over 1,000 adults affected by disabilities and
over 200 children with disabilities. The pilot speech
therapy project focuses on families CABDICO
works with in Siem Reap province. Families in
rural Siem Reap cannot easily access healthcare
facilities, so CABDICO disability workers cross
great distances and challenging unpaved roads to
visit families in their homes.
CABDICO operates within a community based
rehabilitation framework. Community based
rehabilitation is a holistic strategy for the
rehabilitation, equalisation of opportunities
and social inclusion of all children and adults
with disabilities (Mannan and Turnbull, 2007:2).
Community based rehabilitation principles include
utilising local knowledge and resources, involving
community in planning and linking together
education, health, and social systems (ibid.).
Community based rehabilitation aims to treat the
whole child, involving integrated treatment of the
physical, mental and psychological expressions of
the childs diagnosis, transferring knowledge to
families, and working with the wider community
(ibid.). Disability workers who participated in
OICs basic speech therapy training have already
been treating children with disabilities, some for
many years. OICs basic speech therapy training
develops disability workers abilities to provide
essential treatment strategies missing from the
whole.

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CABDICO works with community volunteers and


teachers to identify children with disabilities as
soon as possible and provide early intervention.
However, as knowledge of communication and
swallowing disabilities is limited, children are
nearly always referred to CABDICO for other
more obvious physical impairments. CABDICOs
Community Rehabilitation Officers then work
with families in their homes to transfer knowledge
about how to treat their childs disability. Most
of the children CABDICO conducts basic speech
therapy with have cerebral palsy or cleft lip and
palate.
OIC: The Cambodia Project fills a substantial
gap within CABDICOs community based
rehabilitation framework and within wider
provision of disability services throughout
Cambodia. OIC claims that an estimated one in
25 Cambodian people require access to speech
therapy, and yet there is currently not one
Cambodian university trained speech therapist.
With no university course training in speech
therapy, minimal government policy that explicitly
references the need for speech therapy and a lack

of coordination in the sector, the challenge is


significant.
Cambodias National Plan of Action for Persons
with Disabilities 2008-2011 calls for improved
referral systems, accessible and specialised
services and inclusive education for children with
disabilities. The Ministry of Education, Youth and
Sport ratified its Policy on Education for Children
with Disabilities in 2008, which includes raising
awareness about disability, developing teaching
aids and identifying and enrolling children
with disabilities in schools. Yet attending school
requires the physical, mental and psychological
abilities of the child as well as understanding and
support from the childs family, teacher and peers.
Most parents keep children with disabilities out of
school because they do not believe their children
can learn or worry that their child will be bullied
(Evans et al., 2014). VanLeit, et al. (2011) advocate
for assertive outreach to improve awareness of
disabilities in Cambodia and service delivery. As
discussed below, OICs speech therapy project not
only aims to build disability workers knowledge,
but also awareness across Cambodian society.

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2.2 A new baby


Cambodian staff at CABDICO and OIC described
the speech therapy pilot as a new baby
something so new it cannot be fully understood or
stand on its own yet. Something that can flourish
with attentive care.
As outlined above, speech therapy, as a practice
and as a general concept, is very new in
Cambodian society. Few speech therapy resources
exist in the Khmer language, and there are no
frameworks for Cambodian best practice. OIC
aims to develop culturally relevant and effective
resources and programs through the pilot.
Learning processes such as this evaluation help to
achieve these aims. Many successes and challenges
identified in this evaluation can be attributed
to the originality of OICs project. The new and
unique challenges of creating Cambodian speech
therapy practice run throughout the pilot design,
implementation and surrounding environment.
Honest assessment of project outcomes is
important to OIC as it moves into the next phase of
this project. However, impact cannot be accurately
assessed over the pilots short timeframe. In
addition, OIC is well aware that positive outcomes
for children assessed in this project depend on the
coordinated actions of training, family involvement
in treatment, and many other interconnected
contextual factors. Nevertheless, pilot training
has achieved its aims. While pilot implementation
revealed important lessons for improvement, it
succeeded in developing appropriate training
programs for Cambodian disability workers. Pilot

training succeeded in building their basic speech


therapy knowledge, skills, and ability to support
significant changes in the lives of children with
communication and swallowing disabilities.
It is not possible to demonstrate OICs impact
according to a validated measure or set of
standards, as these do not yet exist. OIC is
responding to feedback from trainees, partner
organisations, and professional experts, as
evidenced by effective adjustments made
throughout the pilot phase and strategic plans
currently in process. This learning practice is
valuable, but must be founded upon thorough
monitoring practices. OIC should implement
comprehensive monitoring during the next phase
of the project. Understanding its effectiveness
and developing future training and practice will
require a substantial amount of detailed data that
partner organisations cannot provide on their own.
Given that the pilot created entirely new practices
with limited resources and time and can already
demonstrate positive outcomes for children with
communication and swallowing disabilities
shows the pilot was effective and highly relevant.
This relevance and pronounced need for speech
therapy services will push OIC to act and expand.
Nevertheless, because speech therapy remains
a novel practice in Cambodia, in its trial phase,
expansion should occur with care, extensive
documentation and extensive communication
between all partners.

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2.3 Pilot training


OIC coordinated basic training to address
Cambodias largely overlooked speech therapy
needs. While far from comprehensive, this training
built 19 trainees capacity to treat basic speech
therapy needs. In total, these 19 trainees work
with 100 families and are imparting their new
knowledge to other workers and teachers. As OIC
learns more from its partners about the needs
and realities of implementation, it can develop
comprehensive professional speech therapy
curriculum that is grounded and relevant to the
Cambodian culture and context.
Throughout 2014, OIC searched for professional
organisations willing to volunteer training, and
thus three separate organisations delivered three
separate training programs in January, February,
and October 2014. Each organisation delivered
their training in English, working with a Khmer
interpreter. Training presentation slides and
handouts were provided in Khmer. Furthermore,
all training programs were supervised and
approved by OICs Senior Technical Advisor, an
experienced speech therapist, to ensure content
was linguistically and academically appropriate.
James Cook Universitys Department of Speech
Pathology in Australia was the first institution
to respond to OICs call for volunteer training.
James Cook University delivered the first training
program over nine days in January 2014. James
Cook Universitys course covered speech and
language disabilities as well as principles of
assessment and intervention (see Table 1). Sixteen
staff members from four organisations in Siem
Reap attended, including CABDICO staff (see
Table 1).

The Centre for Child and Adolescent Mental


Health (CCAMH), a Cambodian organisation,
delivered the second training session over five
days in February 2014. CCAMH trainers were
trained by Singaporean speech therapists, and
the training program was supervised by an
Australian volunteer speech therapist. This session
responded to trainees request for knowledge on
swallowing disabilities, and delivered culturally
appropriate training. OIC did not keep appropriate
documentation of training content and attendees.
However, OIC questionnaires delivered after
this training indicated that trainees knowledge
of speech therapy had increased. Questionnaires
also revealed that their confidence in applying
this knowledge was limited, and more hands on
training was necessary.
The third training session was developed and
led by Orthophonistes du Monde, a French
organisation with strong experience conducting
speech therapy training in developing countries.
Twelve staff from three organisations attended the
14 day training course in October 2014, including
CABDICO (see Table 1). Training content included
hearing, voice and swallowing disabilities, as well
as game development and playing with children
with disabilities (see Table 1). Orthophonistes du
Monde used activities, role play and site visits to
work with theory in practical ways.
In addition to disability workers training, OIC also
conducted a workshop for parents and teachers
in June 2014 to raise their awareness of treating
children with disabilities and increase their
knowledge on language stimulation techniques.
Table 1 summarises the attendees, content and
assessment for the training sessions.

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PROGRAM 1
JAN 2014

TOPICS COVERED

PARTICIPANTS

2 Angkor Hospital for


Children staff:
-- 1 nursing team leader
-- 1 physiotherapist

3 Grace House
disability workers

2 Sangkheum Centre
caregivers

6 CABDICO staff:
-- 3 child rehab officers
-- 2 community
development officers
-- 1 field supervisor

PROGRAM 3
JUN 2014

19 parents of children
with communication
and swallowing
disabilities
29 teachers

PROGRAM 4
OCT 2014

7 CABDICO staff:
-- 3 child rehab officers
-- 2 community
development officers
-- 1 field supervisor
-- 1 finance and admin
advisor

3 Angkor Hospital for


Children staff
-- 2 physiotherapists
-- 1 breastfeeding
counsellor

2 Grace House
disability workers

16 total

6 total

48 total

12 total

Overview of
communication,
feeding, and swallowing
disabilities
Acquisition of language
Biomedical
considerations
Cultural, social and
linguistic foundations
Principles of
intervention
Cognition
Multimodal
communication
Language facilitation
techniques

Vocabulary training
Language stimulation
techniques

Pre-training knowledge
questionnaires
Qualitative
questionnaires
post-training

Parent baseline
questionnaire
(pre-treatment and
pre-training) (January
2014)
Parent post-training
questionnaires (May
2014)
Teacher pre- and posttraining questionnaires
(June 2014)

ASSESSMENT

9 CABDICO staff:
-- 3 child rehab officers
-- 3 community
development officers
-- 1 field supervisor
-- 2 Kep staff

PROGRAM 2
FEB 2014

Swallowing: diagnosis,
foods, positioning for
eating and drinking,
advice
Communication:
modelling,
reinforcement
Socialisation: advice to
neighbours, teachers,
community
Referrals

Knowledge quiz

Post-training knowledge
questionnaires

Table 1: 2014 Pilot training programs

Overview of speech
therapy
Hearing loss
Swallowing disabilities
Fluency disabilities
Techniques to promote
speech and language
development

Pre-training
questionnaires (n=12)
Mid-training
questionnaires (n= 7)
Post-training
questionnaires (n=11)

S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 1 9

Family happiness occurs when he can speak more


words and clearer than before. For instance, the
parents can understand his needs. More specifically,
he can eat both soft and hard food. And he has more
friends, and they understand his communication.
Right now, he can be far from his mother.
- Mother of an eight year old boy with cerebral palsy, as reported to disability worker -

20 | OIC: THE CAMBODIA PROJECT

3 Scope &
methodology
OIC identified the following objectives for this
evaluation:
1. Determine the impact of the speech therapy
training program in regards to:
Participants knowledge of speech therapy
Participants ability to provide speech
therapy interventions
The communication and swallowing
outcomes of children with disabilities
who are currently receiving services from
CABDICO
2. Identify any barriers faced by participants in
implementing speech therapy interventions
3. Determine the sustainability of the training
including cultural sensitivity, training
methodology and appropriateness of content
4. Provide recommendations that will guide the
content and format of future speech therapy
training programs.
Early discussions with OIC management
demonstrated interest in a learning and reflection
evaluation process, rather than attributing
responsibility for all successes or failures. Because
the project is focused on locally delivered services
and strong partnerships with local organisations,
this evaluation aimed to spark an evaluation
process among all OIC and CABDICO staff
who implemented the pilot. Through an active,
participatory process, the evaluation could develop
staffs own monitoring and evaluation practice.

It also became apparent that some of the objectives


listed above could not be rigorously delivered
due to the limited monitoring of the pilot phase.
OIC succeeded in gathering certain types of data,
such as baseline data for 19 case study families
as well as 19 trainees pre-training, post-training
and mid-term evaluations. However, childrens
communication and swallowing outcomes were
not systematically documented or shared between
partner organisations.
Monitoring data is especially precious for a
project developing an entirely new health practice.
Therefore, an additional objective underpinning
this evaluation was to assess OICs monitoring
capabilities and recommend next steps for
strengthening monitoring practice. Monitoring is
discussed further in Section 4.10.
All data analysed by OIC and the evaluators was
provided with informed consent. In addition
to reviewing questionnaires, client files and
organisational documents, the evaluation
conducted focus groups and interviews to gather
perspectives from disability workers, managers
and professional advisors who implemented the
pilot. Gathering together different types of data
from different sources allowed the evaluation to
triangulate (cross-check) findings and verify their
accuracy. See Appendix A for a breakdown of all
evaluation activities.
Due to communication breakdowns between
the various organisations involved in pilot
training, the evaluator was only able to meet with

S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 2 1

He can swallow in a better way, for instance, he does


not so often cough or get food stuck in the throat. He can
position his neck. His family members are very happy
when they see he is healthy. Now he can turn his body
over, and he also can tell his needs by body language.
- Aunt of a three year old boy with cerebral palsy, as reported to disability worker -

CABDICO trainees. Throughout this report the


terms disability workers or trainees refer to all
19 trainees (who completed questionnaires), while
the term participants refers to CABDICO staff
who participated in evaluation research. See Table
1 and Appendix A.
CABDICO specifically targets families spread
throughout rural Siem Reap province, often on
farms connected to main highways via challenging
unpaved roads. To efficiently assess outcomes for
children receiving basic speech therapy services,
the evaluator photographed full copies of 12
follow-up books community rehabilitation
officers use to track childrens treatment and
progress. OICs project coordinator analysed these
copies and developed key assessments in English.
See Appendix C. The evaluation also trained
CABDICO staff to use the Most Significant Change
(MSC) method. Staff used the Most Significant
Change method to collect families stories of the
most important change they witnessed in their
child and in family life since basic speech therapy
treatment began. See Appendix B.
The Most Significant Change method was tested
for several reasons. Most Significant Change
method allows families to put forward their
perspectives on what changes are important to

them, which may or may not align with OICs aims


and expectations. VanLeit, et al. (2007:45) note a
growing evidence that empowerment approaches
to service delivery lead to better health outcomes.
They assert that in order to realise positive
outcomes for Cambodian children with disabilities,
participatory approaches to working with families
need to be emphasised (ibid.).
Over the course of one weeks field visits, three
CABDICO disability workers consulted 13 families
in remote villages throughout Siem Reap province
and reported their stories. This methodology
was far more efficient than one foreign evaluator
and one project coordinator attempting to locate,
recruit, interview and translate transcripts for 13
families that they had never met and would likely
not trust.
The Most Significant Change method also created
an opportunity for participants to actively develop
their monitoring and evaluation skills. One
disability worker reported that though she works
regularly with these families, she never expected
to hear the significant stories of change reported to
her. One family told her that they never expected
to be asked which aspects of speech therapy
treatment have been important to them.

22 | OIC: THE CAMBODIA PROJECT

4 Findings
4.1 Developing and applying
knowledge
Training sessions
Disability workers overwhelmingly expressed
gratitude for their training. While they
understandably requested more training, they
nonetheless found everything they learned useful:

I think I got lots of knowledge and skill


that before I never had. For example, I know
educational games to assess the voice of the
child, and I can evaluate sound I also know
how to teach the child, to advise [the family
about] the appropriate position for eating or
swallowing. Also a variety of techniques on
how to work with children. For example, if I
cannot do educational games, then I can use
pictures.
In questionnaires and discussion, trainees
consistently reported that the most useful aspects
of training were methods using clearly formatted,
practical resources. One Community Rehabilitation
Officer noted she particularly appreciated the
format of the third training, with clear details such
as using a Khmer alphabet sound table. While the
lecture based style of teaching used in the first
two training courses is customary in Cambodia,
feedback from trainees demonstrates that the
practical, hands-on learning style of the third
course was more effective.
Trainees feedback on their final training session
indicates the knowledge and skills trainees value

the most, as well as gaps that remain. Trainees


rated the most important topics as:



Effective treatment of swallowing difficulty


Speech therapy [basic principles]
Communication disabilities
Pronunciation difficulties.

Among many topics trainees wanted to learn more


about, those listed more often were:
Resource (game) development
Pronunciation impairment identification and
management
Infants sucking and swallowing.
In evaluation discussions, participants wanted
further specifics into:
Communication and swallowing disabilities
in general
Problem identification
Developing resources (games) and
implementing practical techniques.
Trainees consistently agreed that training
improved their practice, noting their increased
knowledge and skills. The vast majority of
trainees also reported that their skills remain
limited and that they wish to have more training.
Some trainees noted that they did not have an
opportunity to practice learnt strategies with their
clientele during training, or that they do not have a
local speech therapy expert nearby to consult.

S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 2 3

I thought speech was only about


talking, but after I received the training,
I realised that communication is an art
for helping people change their living, to
provide them confidence, and also to make
family and people around them feel more
confident. So yeah, it seems amazing that
a child who has already been neglected,
who cannot be communicated with, can
express themselves and can be played
with. But if we talk about the status of
the community I know that these are
new things for them.

24 | OIC: THE CAMBODIA PROJECT

Putting training into action


In interviews, two Community Rehabilitation
Officers identified their biggest training successes
as children with cleft lip/palate. Community
Rehabilitation Officers helped these children
become healthy enough for surgery and develop
good speech post-surgery. This required teaching
families how to complete pronunciation exercises
with their child, using games as reinforcement.
The third Community Rehabilitation Officers
biggest success was with a client with cerebral
palsy. She reported that the clients family and
teachers did not predict that he would be able
to complete everyday activities or walk. After
working with this child for two years on physical
activities as well as including one years provision
of basic speech therapy instruction, the client
can now walk, talk and complete everyday
activities independently. For all three Community
Rehabilitation Officers, these successes depended
on engaging the childs family in their childs
treatment.
Three CABDICO disability workers reported their
biggest challenges are treating children with severe
disabilities. They felt that these children cannot
understand them, and they could provide little
assistance to these families:

The child with autism, as I have a case with


very severe form, he knows nothing. When
we give him something he only bites it then
throws away; he cannot understand us
The childs recognition level seems nothing.
Yes, I can [use what I have learned from the
training], but with the least productivity.
All three did report, however, that training helped
them devise some strategies to support children
with severe disabilities. One noted that training
increased her ability to observe clients facial and
body cues. She used these skills to assist the family
of a 13 year old boy with severe cerebral palsy and
epilepsy to observe such cues and understand their
childs needs.

Questionnaires and discussion revealed that the


trained disability workers feel most confident
implementing speech therapy techniques through
games. Participants recognised that games, like
any tool, must be appropriate for a childs specific
needs. They expressed a desire to develop more
treatment specific speech therapy games:

I think all the games are important, but those


games are not applicable to the same children.
Some games can be used with one kind of
disability and other games with others. They
are not applicable to the same situation.
If the child seems sick then we cannot
play [games] with them; only if that child is
energetic, happy, smiling.
I wish speech therapy to develop more new
games to play with children.
Games allow disability workers and families
to interact with a child and encourage the
development of speech therapy goals through play.

Training has changed my life from


a person who knows nothing about
speech therapy to a person who knows
the basic concepts, for example, specific
services for the specific problems
children might have. I can identify the
right way to help a child to pronounce
word by word correctly by using toys,
games and local real things [devices].

S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 2 5

Confidence and frameworks


Mid-term questionnaires completed in June
2014 demonstrate an increase in trainees speech
therapy knowledge but a decline in many trainees
confidence in speech therapy treatment. See
Appendix E. Because these results were captured
after the first two training sessions but before the
third, they do not accurately reflect outcomes of the
complete course of pilot training. They do suggest,
as trainees did, that training should provide
opportunities to practice and role play as much as
possible. Such practice developed and reinforced
learned skills and increased trainees confidence
and ability to apply learning in practical ways.
In focus groups, CABDICO disability workers and
managers stressed the importance of having clear
speech therapy guidelines to follow. They counted
the lack of guidelines as an important barrier
to their work. Interviews with speech therapy
professionals also stressed the importance of
developing culturally appropriate speech therapy
guidelines in Khmer. The pilot was the first step
for OIC to develop such guidelines, as currently,
none exist.
This lack of guidelines, compounded by the lack of
connection between training sessions, prevented
the pilot from having an overarching framework.
Participants expressed frustration about the lack
of a training framework as well as anxiety about
not knowing what or how much training they may
receive in the future:

Normally we study by grade or level, so


I am not sure about how many sessions in
speech therapy. I dont know about it at all.
For example, if OIC has a specific amount of
sessions, first step is this one, second is that
and so forth. Then we feel more confident in
ourselves but when some this training and
next time that training over there, then we
wouldnt know what is what.

Previously OIC trained its staff by people


from France, Australia so when they
come they did not connect together between
sessions We still need OIC project to look
for new methods or any step by step method in
order to train its staff OIC should prepare
to train month by month, level by level.
None of these Community Rehabilitation Officers
knew whether they would receive further speech
therapy training. In questionnaires and/or
discussion, all trainees requested more training.
Trainees most often reported that they wanted
further training in:
Communication
Swallowing, and
Resource development.
Throughout the evaluation, disability workers
demonstrated a critical and reflective approach to
their practice:

When we play with children, I am suspicious


that we try to tell children how to play like
this or like that. I personally think that maybe
to play this way is easier for children to
understand, but in reality I am not sure if its
easier for children to understand. That point
I dont know, because sometimes we think
that children may understand, but in reality,
children dont know if they understand. We
dont know clearly; we cant feel their mind.
Disability workers continually examine the
effectiveness of their practice and work through
how to apply their training to the local context.
This evaluation is one step in a process where
trainees can offer valuable insights into developing
culturally appropriate speech therapy.

26 | OIC: THE CAMBODIA PROJECT

4.2 Nurturing organisational relationships


The pilot paired OICs ability to organise
professional speech therapy training with
CABDICOs ability to implement through its
strong relationships in target communities.
Both OIC and CABDICO staff independently
highlighted CABDICOs solid relationship
building as a key asset in pilot implementation.
One Community Rehabilitation Officer also
reported that training on good communication had
improved the communication between CABDICO
staff, allowing them to understand each other
better and work together with more friendliness.
The foundation for OIC and CABDICOs
commitment is the history and trust between
CABDICO and OICs Managing Director and staff.
All CABDICO participants noted that they trust the
Managing Director, despite pilot uncertainties such
as the lack of a training framework. Because they
have worked together for years, CABDICO staff
felt that the Managing Director understands their
work and needs. However, one participant noted
that new OIC staff do not understand CABDICOs
work, even though new staff may help lessen
CABDICOs workload.
OIC staff interviewed in Phnom Penh and
CABDICO staff interviewed in Siem Reap were
not aware of what the other is doing. Both sides
recognise that the time necessary for proper
communication was not available through a
lack of resources. CABDICO also identified time
constraints as a barrier to pilot implementation:

Speech therapy training is good because it


is one of capacity building for all of you. I do
understand that when you attend the training,
you have little time to implement your core
activities, but you can get new skills I
understand that some OIC project activities
also can disturb your core activities, but if
it happens very often, then we have to think
about that and have a talk. To manage the
time.
Thus, while speech therapys value is
acknowledged, its prioritisation may be difficult,
even in an organisation like CABDICO where the
organisational buy-in for speech therapy training
is relatively high.
Building relationships and skills, while managing
all parties time constraints, is a complex and
critical component in implementing speech
therapy training. OIC staff interviewed recognised
that their communication with local organisations
needs to be improved, as strong partnerships are
critical to its success.

We felt that people from CABDICO


have solid and friendly links. They
really form a team
ODM

S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 2 7

4.3 Engaging families and wider communities


CABDICO trainees conducted baseline surveys
and identified 19 children to track as OIC case
studies. Currently, 13 of these children are in the
CABDICO program, while six families elected not
to receive rehabilitation services. Of those six, three
have a child with autism and five have a child who
is aged ten years or older.
In interviews, disability workers reported that
most families understand and support their
treatment programs. These disability workers
stressed that families daily work with the child
is far more important than disability workers
periodic activities:

We teach the family... things they should


teach to the children so that they can teach by
themselves at home.
They have a speech problem, but the people
who are around them are the ones who
treat them, so everybody has to know or be
involved so that children who have speech
can improve--in order to make them talk the
people around them must talk.
Disability workers understand that family-centred
services strengthen the communication bonds
between child and family and promote positive
outcomes (Paul and Roth, 2011). However, focus
groups stressed that lack of community awareness
is a major barrier to implementing speech therapy
services. Disability workers identified two reasons
why some families do not work with them: a)
lack of time for speech therapy activities due to
poverty-induced heavy workloads and b) lack of
trust in speech therapy treatment. While the focus
group debated the extent of family mistrust, all
agreed that it is largely caused by a lack of speech
therapy awareness throughout Cambodia:

Some families dont trust us that we can


help improve their child I think they assess
their childs condition, they think that we
just talk, make some easy exercises or just
play with them, which they think may not be
helpful for their children to be able to recover
completely.

The mother said his voice is clearer


than before, so she does not need to
verify [what he said]. In regards to
swallowing, he is good. In short, the
family members are very happy when
he can speak better. But there is only
one thing that they are not happy
with; the child cannot walk
- Mother of an 11 year old boy with cerebral palsy as
reported to disability worker -

It will help OIC a lot once they can


raise community awareness. When the
family members know the cause and
effects, we understand each other, so
the process will be smooth
- Disability worker -

28 | OIC: THE CAMBODIA PROJECT

Before they meet us most of the families


have already spent a lot of money. Like they
tried to see traditional healer, tried to consult
with a physician as they were told different
things by their neighbours From the instant
we start, when we train them, that it is not
like... the things that they have done with
their children before We are not treating
with medications, not to make them improve
quickly in just one month or two. We have to
work with them in order to have them work
with their children.
Because no common understanding of speech
therapy treatment exists, and parents are
sceptical considering they have already invested
in treatment that has not worked, disability
workers must work very hard to gain families
trust that speech therapy treatment is worthwhile.
CABDICO staff identified their good relationships
with families and wider communities as a
strength and strategy for increasing family trust
and community awareness. A 2012 evaluation
of CABDICO highlighted that disability workers
need more training on dealing with families
expectations (Thomas and Yeang, 2012). Because
families expectations may differ greatly from what
disability workers can provide, managing these
expectations should be a component of future
training and mentoring.
As quoted at the start of this section, one mother
of an 11 year old boy with cerebral palsy reported
that the family is really happy that her son can
speak better, but they are not happy that he cannot
walk. This corresponds with a high prevalence
of families who set walking as a key long-term
goal, as documented in client follow-up books.
The high value placed on walking, regardless of
the childs speech and communication potential,
is a strong challenge disability workers face in
implementing speech therapy services. While
walking may be a realistic goal for some children,
it is well-documented that children with cerebral
palsy who do not walk after the age of five are
very unlikely to ever walk (Palisano et al, 1997). It
is unknown whether the mother quoted above is
unaware or unaccepting of this prognosis.
In group discussion, participants voted limited
family income as the strongest barrier to

implementing basic speech therapy services. While


training may recommend certain foods to improve
health and swallowing, families may respond that
they are unable to afford these foods:

When the child has food with much protein


they can absorb energy and support the
body, but in contrast the families that we
work with, they dont have enough income
to support the child who has swallowing
problems. That is the problem.
Families may also have little time to meet with
disability workers and/or practice speech therapy
activities with their child:

The family is very poor and we dont have


enough capability to help them [financially],
so they have to go out to earn money. They
rarely stay at home and when we visit,
we almost never meet them. We meet only
their children who are disabled who are
sometimes left with an old grandmother or
with their neighbours. And they are not cared
for well enough.
Participants could not identify a solution to
addressing these barriers, other than jokingly
suggesting that OIC give families some money.
Nevertheless, participants views align with
Wing, et al. (2007:25), who assert that:
When standard practices are inconsistent
with the familys cultural values and
behaviours, and therefore unnatural for
the child socialised in this environment,
alternative strategies must be considered.
Despite the challenges of changing communities
mindsets, participants did observe changes in
families attitudes about basic speech therapy
treatment:

When I started to work in this organisation,


people entirely expected help like money,
food, as their children need food. So they are
always complaining about their family status
that they need food, they need jobs, or they
need money. But the current status is that
they seem more interested in their childrens
treatment.

S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 2 9

The change is in speaking since he has received the


therapy. Before he was often sick while now he is better.
So he has changed a lot in speaking because his mouth is
not sticky. Moreover, it is getter easier for him to speak,
his parents are especially happy when their child can go to
school. In short, the parents are happy when their childs
swallowing and communicating disabilities are being
solved from time to time.
- Mother of an eight year old boy with cerebral palsy, as reported to disability worker -

30 | OIC: THE CAMBODIA PROJECT

4.4 Initial outcomes


Outcomes observed at this stage only indicate
the potential of OICs project in the future. Only
four months have passed since the third training
session, and all stakeholders interviewed agree
that speech therapy is a long-term process. The
pilot is an important first step within a much
more extensive process. Impacts are defined as
long-term influence, and the impacts that OIC
generates can only be observed over the long-term.
Nevertheless, in its first year the project has
generated several positive changes for children
with communication and swallowing disabilities,
and their families.
Outcomes for disability workers
In surveys following the final training session, all
trainees reported they gained crucial knowledge,
especially in regards to communication,
pronunciation and treating swallowing difficulties.
See Appendix D. Trainees reported that this
knowledge would change the way they work:

Its easier to understand and to work with


children having speech therapy.
It helps us to be more confident in helping
children as well as ways to communicate with
the family more effectively.
The CABDICO focus group identified knowledge,
skills, and attributes necessary for good
Cambodian speech therapy practice, including
knowledge of the childs specific needs and ability
to evaluate current and future issues. When
asked whether training had developed these, all
stated that their knowledge and skills had greatly
improved. They noted things such as the ability
to identify the disability level of the child and
knowledge of useful games or toys to fill the gap
between the parent and child.
Participants also noted how training supported
their personal development. One Community
Rehabilitation Officer reported that training
helped her to have more relationships with the

children because speech teaches me how to play with


children or the techniques to let the children show
their impressions. Another noted that training
developed her strong confidence to identify treatment
options, as before I knew almost nothing about how to
help a child with speech problems.
In order to practice for Most Significant Change
method interviews, CABDICO staff interviewed
one another about the most significant changes to
their own practice since speech therapy training.
The strong recurring theme in these stories was
the significant changes in their ability to identify,
diagnose and address speech therapy needs. Two
participants reported that they can better train
parents to provide the right support. One new staff
member noted how training increased her skills,
knowledge and confidence. Her peer-interviewer
reported that:

She gained communication skills. She can


build good relationship with families she
works with. Regarding knowledge, she knows
how to work with a child, which she never
knew about before. Moreover, she is braver
than before, which comes from practicing role
play and playing games during the training
course. She knows much more how to reply to
a childs needs or problems. For example, if a
child has a swallowing disability, she is able
to position child for better swallowing. She
can diagnose a childs problems.
See Appendix C for all disability worker stories.

I think that success is not a


complete success at once, but it
is gradual
- Disability worker -

S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 3 1

Outcomes for families


The evaluation team reviewed 12 follow-up
books for children to assess communication
and swallowing outcomes (see Appendix C).
Disability workers use these books to record
medical histories, long-term and short-term
goals, the childs developmental progress and the
activities conducted during each visit. However,
gaps in this data set made it quite difficult for the
evaluation team to gather a clear and consistent set
of outcomes. Some results columns showed that a
child was attending school or independently doing

daily tasks, but it was often not clear whether or


not the child had achieved a particular goal.
Nineteen families of children completed
questionnaires in January 2014 before speech
therapy training, and in May 2014 after CABDICO
trainees put the first two training sessions into
practice. These questionnaires, summarised
in Table 2, demonstrate a dramatic increase in
families ability to understand their children.
For example, the number of children who could
communicate with their family most of the time
increased from 4/19 (21%) to 16/19 (84%).

32 | OIC: THE CAMBODIA PROJECT

NEVER
I understand 1 0
what my child
wants

LITTLE
OF TIME

SOME
TIMES

NEARLY ALWAYS
ALWAYS

RESULT

1 0

3 1

13 8

1 10

The number of parents who


understood what their child wants
at all times increased from 1/19
(5%) to 10/19 (52%)

My child can
says what
she/he needs

3 1

2 1

8 2

6 10

0 5

The number of children who could


say what they needed most of the
time increased from 6/19 (31%) to
15/19 (78%)

My child can
eat, drink
and swallow
easily

0 0

5 0

5 5

4 8

4 6

The number of children who could


eat, drink and swallow easily, most
of the time, increased from 8/19
(42%) to 14/19 (73%)

I know how 1 0
to help my
child be a
better speaker

3 0

11 8

4 11

0 0

The number of parents who knew


how to help their child become a
better speaker, most of the time,
increased from 4/19 (21%) to 11/19
(58%)

My child can 0 0
communicate
with members
of the family

6 0

9 3

4 10

0 6

The number of children who could


communicate with their family
most of the time increased from
4/19 (21%) to 16/19 (84%)

My child can 0 0
communicate
with friends

8 1

7 6

4 9

0 3

The number of children who could


communicate with their friends
most of the time increased from
4/19 (21%) to 12/19 (63%)

My child
4 1
participates
in community
activities
in spite
of her/his
communication
problem

6 2

6 7

3 8

0 1

The number of children who could


participate in the community most
of the time increased from 3/19
(15%) to 9/19 (47%)

My child is 3 0
confident
with the way
she/he speaks

5 6

3 8

The number of children who could


say what they needed most of the
time increased from 3/19 (15%) to
12/19 (63%)

I can use the 0 0


information
from the
staff to help
my child
communicate

11 6

4 11

The number of parents who felt


they had useful information from
the staff, to help their children
most of the time increased from
4/19 (31%) to 14/19 (74%)

Table 2: Parent questionnaires quantitative results

Italics = pre-questionnaires Jan, 2014


Bold = post-questionnaires May, 2014
Note: Results reflect four months of basic ST services

S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 3 3

While community education is a long-term


process, being able to communicate with children
with communication and swallowing disabilities
can dramatically change perceptions and spark
families interest in their childs treatment.
Seeing a child communicate and participate in
the community is a crucial step in overcoming
perceptions of disability and speech therapy.
CABDICO disability workers interviewed 13
selected families about the most significant
changes they have observed since basic speech
therapy treatment began. Families reported the
outcomes they deem most valuable:
Nine reported significant improvements in
their childs swallowing.
Seven reported much clearer speaking.
Three other families of non-verbal children
noted better communication through body
language.
About half of families reported increased
happiness since their childs communication
improved.
Another half noted that they have more time
for other tasks, or for income generation,
now that the child is more independent.
For three, the most significant change was
that their child can go to school.
For four, it was significant to parents that
their child is making new friends.
See Appendix B for all families Most Significant
Change stories.

The most significant change


for him is that he can go to
school because his voice is clear
enough. For example, only
one out of ten words is not so
clear, while before [basic speech
therapy], ten words that he
speaks are not clear at all. As
a result, he can do some things
by himself, and he can tell
about his needs. The mother
said that the most interesting
thing is that he can sing, and
his sound is understandable.
- Mother of a five year old boy with cleft palate, as reported
to disability worker -

34 | OIC: THE CAMBODIA PROJECT

5 Recommendations
Create a clear training framework
Trainees consistently reported that they needed
more training, and did not know whether or
when further training would be provided. A clear
training framework will reduce trainees anxiety
about their partial knowledge. A clear training
framework, presented from the first session, will
reassure disability workers about their progress.
It will also help disability workers and their
managers understand the demands, expectations
and opportunities training entails.
Consider a long series of short training sessions
OIC must balance the need for rigorous training
with the realities of trainees time constraints and
the limited availability of professional speech
therapy volunteers. Employing a hub and spoke
model of training would effectively meet these
needs and challenges. A hub professional speech
therapy trainer/mentor would deliver a long series
of short workshops and mentoring, dividing their
time across several different groups in different
areas (spokes), visiting each at regular intervals
for short training sessions and mentoring.
Orthophonistes du Monde (2014) highlighted
that many training topics are completely new
to disability workers, and should be revisited
multiple times to reinforce learning. One disability
worker reflected: I cannot remember all of [the
training I received] and I want to have the same
training as before, but I want [OIC] to look for
new methods to add on top of those. Feedback
from trainers, disability workers and technical
specialists suggests that multiple training sessions
are necessary in order to grasp a sufficient breadth
of knowledge, fully absorb new concepts, and
effectively apply this knowledge. Orthophonistes
du Monde also found that two weeks of training
barely scratched the surface, yet acknowledged
the high opportunity cost of removing disability
workers from their regular duties for two weeks

(Orthophonistes du Monde, 2014). Still other


potential trainees could not get approval from their
managers to attend Orthophonistes du Monde
training.
Use pilot feedback to create grounded curriculum
Orthophonistes du Monde modified its training
once it had a clearer idea of trainees work context.
Prior trainees should be involved in developing
future curriculum. While OICs project coordinator
can guide the project in terms of culturally
appropriate project management, trainees must
have specific knowledge of implementing speech
therapy training. All trainees are time constrained
professionals and should be compensated for their
time in some fashion (financially or otherwise).
Develop the knowledge and attributes disability
workers need
Feedback from all trainees demonstrated that the
speech therapy topics disability workers need most
are:







Communication targets
Swallowing techniques
Resource development
Pronunciation and voice techniques
Setting and monitoring goals
Transferring knowledge to families
Managing family expectations, and
Treating children with severe disabilities.

In discussion, CABDICO staff identified the


top five skills or personal attributes essential
to successfully implementing speech therapy in
Cambodia. All mentioned at least one item related
to knowledge or skills such as:
Knowledge of the persons specific needs,
and
Ability to analyse current and future
problems.

S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 3 5

Most of the items reported were personal


characteristics, most often:




Patience
Flexibility
Gentleness
Motivation, and
Enjoyment of work.

When asked how training could develop these


attributes, one speech therapy professional
who supervised training noted that they can be
developed through modelling behaviour and role
play exercises. She reported that Orthophonistes
du Monde trainers made trainees feel comfortable
with their expressively warm and friendly
behaviour.
It is also important to tailor training to the
education level and practice of different disability
workers, from community based workers to
hospital physiotherapists. Orthophonistes du
Monde found that trainees experience and
knowledge varied greatly. While they noted that
exchange between these groups is enriching, it
is likely much more effective to divide groups
of trainees according to their roles and general
knowledge level. Shorter meetings that raise
awareness and build networks are better venues
for exchange between different health and
disability workers.
Train through action, practice, tools and bodies
Trainees lack of confidence in applying speech
therapy theory indicates a lack of confidence
in their theoretical knowledge. Role play and
game development allowed trainees to apply
their learning and build confidence. It may be
more effective to begin training with practical
exercise and case studies, then illustrate the theory
underpinning these concrete examples.
In order to discuss speech therapy treatment, a
significant amount of time in training sessions was
devoted to teaching the basic anatomy of the throat

and other body structures involved in treatment.


Basic anatomy is often not a part of disability
workers public education so demonstrating and
acting out how bodies communicate is a new and
enriching practice.
Emphasise developing and documenting goals
CABDICO disability workers reported that they do
not feel confident creating and assessing goals:

Yes, we have the follow-up book, and we


have planning for the children about what
results we should see within a specific period
of months. I am not sure on how to fill out
that book as I am pretty new.
I always set the goal, but I am not sure if I
am doing it in the right way. If there are any
other trainings, I want to participate as much
as I can so that I can be more confident.
In addition, while community based rehabilitation
aims to treat parent identified goals, family desires
may clash with effective and achievable treatment
plans. One mothers displeasure at her sons
inability to walk highlights a vital challenge to
improving treatment. Rather than struggling with
an unachievable family identified goal, disability
workers can critically investigate the desire that
underpins this goal. In other words, why does the
family want the child to walk? Is it so that the child
can go to school? Contribute to family income?
Does the family want to increase the childs
mobility, socialisation or independence? Through
such a process, disability workers can manage
families expectations while supporting families
goals.
Speech therapy professionals reported the
importance of breaking down family identified
goals into specific SMART goals: Specific,
Measurable, Achievable, Relevant, and
Time-Bound. Developing ability to critically set
and assess goals requires mentoring. In addition,
as discussed elsewhere, thorough documentation

36 | OIC: THE CAMBODIA PROJECT

of activity results and a childs progress towards


short-term and long-term goals will help disability
workers confidently assess whether goals are
appropriate or need revision.
Provide professional and peer mentors
Both OIC speech therapy advisors and disability
workers themselves highlighted the need for
ongoing professional mentoring to develop
disability workers speech therapy skills. All
speech therapy professionals interviewed stressed
that trainees need increased clinical practice and
supervision. They emphasised that professional
therapists receive at least one year of clinical
supervision. All recommended mentoring as a
crucial part of training.

stress that treatment is not just about an individual,


but about creating an inclusive environment rather
than a disabling one. The creation of inclusive
environments in Cambodia will require changing
community mindsets and practices.
As discussed in depth in Section 3.3, lack of
community awareness about the nature and value
of speech therapy is a major barrier to successful
treatment. Wider community education can
increase early identification and intervention
for children with disabilities. It can change the
mindset of families about what to expect from
treatment, as well as the mindset of neighbours
and wider family networks who may contradict
the messaging families receive from disability
workers.

CABDICO participants also suggested that


disability workers should have a speech therapy
mentor, just as they have a physiotherapy mentor
and that they meet with once per month. Many
of the doubts and challenges that disability
workers grapple with, including managing severe
disabilities and setting goals, can be addressed
through partnering disability workers with a
professional mentor.

One disability worker stressed that to change


the behaviour of society in order to make them talk
about every activity is still limited. I think if there is
any method to improve that point, it can decrease my
responsibilities, the children would also improve, and
the families and society would be more closely related
[to each other] than before.

In addition, peer support networks, pairing


former trainees with new ones, can also support
the learning of both groups. Each group of
trainees should be linked to one another to create
opportunities to share learning, resources, and
support. As speech therapy is a very new type of
community health service in Cambodia, training
is limited to short sessions, and local organisations
are typically time and resource strained, building
peer-to-peer support among trainees will
maximise effectiveness. An effective peer-to-peer
network will also require an external facilitator to
coordinate and address communication barriers
should they arise.

Standardised Khmer speech therapy language is


key to effective training and treatment. Training,
learning, documentation, and the necessary
translation between English and Khmer for
all of these, is a substantial burden without a
standardised vocabulary and set of abbreviations.
The novelty of the pilot prevented OIC, trainers
and trainees from using a standardised Khmer
speech therapy language.

Build wider community awareness


This evaluation agrees with participants that
community education should be a key component
of OIC. Social and ecological models of disability

Dream of a common language

OIC did develop a significant amount of resources


between the second and third training to assist all
Cambodian clients with vocabulary development.
Disability workers noted their appreciation for
Khmer resources. Speech therapy professionals
interviewed also expressed the need for a
language assessment tool in Khmer, which would
standardise identification speech impairment
levels.

S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 3 7

As discussed further in Section 4.10, project


documentation needs to be thorough, yet this can
be a considerable burden for disability workers
who cannot use standard abbreviations as other
professional therapists do. At the same time, the
more disability workers document their current
practices, the better OIC will be able to develop
Khmer speech therapy language.
OIC aims to develop speech therapy language and
curriculum though grounded testing in the pilot
and beyond. This evaluation recommends that
OIC prioritise Khmer speech therapy language
development as a core component of pilot
expansion. Shared language is both a long-term
undertaking and crucial to successful Cambodian
speech therapy practice. An in country volunteer
or staff member could liaise with speech therapy
professionals, former trainees, disability workers
and OIC staff to develop Khmer speech therapy
language and abbreviations. Developing this
language will also allow OIC to develop more
basic resources in Khmer for disability workers to
reference. Better Khmer speech therapy resources
will likely improve disability workers confidence
and ability in transferring basic speech therapy
practice to families.

The major barriers of: a) teaching very new subject


material and b) requiring disability workers
and their managers to rededicate time to speech
therapy, can be alleviated through standardised
speech therapy language and abbreviations. In
addition, translation between English and Khmer
documents and discussions is labour-intensive
but necessary to develop effective and culturally
appropriate Cambodian speech therapy. The
project coordinator observed errors or omissions
in some translated project documents. This
evaluation recommends that OIC consistently use
the same professional, health literate translator as
much as possible. This will likely require investing
additional funds into translation services. This
evaluation believes that higher quality translation
will increase the effectiveness of the project
to a degree that will make any increased costs
worthwhile.
Monitor for success
Determining impact is impossible without
monitoring (Boardman, 2014). All stakeholders
consulted for this evaluation made assessments
about the project that were accurate when crosschecked. Nevertheless, OICs monitoring must be
far more thorough and formalised.

38 | OIC: THE CAMBODIA PROJECT

Boardman (2014) notes the effectiveness of utilising


existing data sets and tracking methods rather than
redoing work by requiring separate monitoring
reports. With effectiveness in mind, the evaluators
hoped to use CABDICO follow-up books to
track childrens communication and swallowing
outcomes. When completed thoroughly, these
books are rich data sets demonstrating disability
workers basic speech therapy practice and
outcomes for children with disabilities. Capturing
data from this existing tool would be an effective
use of time and resources for monitoring.
However, while disability workers are generally
documenting their work, much more thorough
accounting is needed regarding the types of
treatment activities conducted, specifics on
childrens ability to perform these activities and
clearer information on the results observed.

They found that males dominate Cambodian


disability organisations and may not account for
the voices of women with disabilities (ibid.).
Conversely, womens organisations do not account
for unique barriers that women with disabilities
experience (ibid.).

Reviewing disability workers records can seem


invasive. It was not the evaluation teams objective
to critique CABDICOs record keeping capacity. In
addition, it is not common practice for Cambodian
organisations to rigorously document their work.
One speech therapy advisor working closely with
hospitals reported that even in professional clinical
settings documentation is light or non-existent. As
OIC expands and works with other organisations
throughout the country, it is likely to suffer
from a lack of the documentation it needs to
monitor training outcomes. This documentation
is critical for OIC to monitor implementation and
create appropriate Cambodian speech therapy
curriculum.

Another key factor to understand and account for


is the childs primary caregiver. Evans, et al. (2014)
found that mothers most often care for Cambodian
children with disabilities. Caregivers level of
education, income and how much time they have
for rehabilitation activities impact outcomes.
Disability workers interviewed noted that many
parents spend most of their time working away
from home, leaving the child with siblings, an
older relative, or a neighbour who may not
have the capacity to properly care for the child.
Disability workers should record information
regarding the childs primary caregiver and report
this to OIC. Monitoring experts note that tracking
from project participants is critical to properly
understanding implementation. Therefore,
OICs monitoring practice will require parent
reporting. Not all parents are literate and most
have high demands on their time. As the use of
mobile phones becomes more widespread in rural
Cambodia, contacting parents by mobile phone
may be a viable option for parents to report on
their childs development.

Little is known about the characteristics of


Cambodian children with disabilities or their
family situations. OICs program is an opportunity
to increase national understanding of these topics.
Gender is one particularly important characteristic
to capture, and OIC should maintain gender
disaggregated data for all its monitoring practices.
Gender roles heavily dictate Cambodias social
structure, and the gendered dimensions of
disability in Cambodia are significant yet poorly
understood. Astbury and Walji (2013) assert that
gender, disability and poverty create a triple
jeopardy for Cambodian women with disabilities.

Handicap International found that Cambodian


boys have an increased risk of disability (Evans,
et al, 2014) and the majority of children with
communication and swallowing disabilities that
CABDICO works with are male. There was no
box on OICs baseline form for gender, though
disability workers filled this in anyway about half
of the time. This evaluation compiled a table of
case study children, and it took checking several
different documents to determine each childs
gender.

Training sessions should cover monitoring


practices and the importance of extensive
documentation. This reinforcement will also help
disability workers to cement their learning and
track the goals they develop for children.

S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 3 9

Whenever OIC conducts monitoring, significant


time must be dedicated to organising and
analysing this data. For example, OIC obtained
excellent data in training evaluations and parent
and teacher questionnaires. These documents
would have been used more effectively for
monitoring and evaluation if more time had been
devoted to analysing and distilling their contents.
This evaluation is one step in OICs larger
monitoring and evaluation practice. All project
stakeholders should have feedback and learning
sessions to engage with this evaluation and
strengthen their monitoring skills.
Keep staff roles clear and bounded
While a young and growing organisation is
inherently fluid, OIC should develop clear and
bounded roles for all staff to: a) avoid confusion,
b) increase efficiency, and c) nurture staffs
professional development. This evaluation found

that training was much more effective and better


documented when supervised by a dedicated
volunteer, rather than added to an existing staff
members list of tasks. Orthophonistes du Monde
noted that their supervising volunteer was very
helpful, as prior to her assistance it was unclear
to them what staff members roles were or who
did what. As discussed in Section 3.2, CABDICO
staff also noted that it is not clear to them who is
responsible for what.
At present, OIC has one local permanent staff
member, the project coordinator, who often serves
as de facto interpreter and translator in addition
to other responsibilities. The project coordinator
was also co-researcher for this evaluation, which
stretched the evaluations capacities as well as the
project coordinators other core responsibilities.
Clearly, with a small team with limited resources,
job sharing is inevitable, but with more funding
towards human resources, these boundaries can be
better developed.

40 | OIC: THE CAMBODIA PROJECT

Focus on volunteers and staff who can contribute


to the biggest needs
OICs current volunteer coordinator is based in
Australia. The project coordinator in Cambodia is
responsible for overseeing volunteers in country,
among a host of other responsibilities. As the pilot
expands, in country volunteer coordination will
likely expand and require dedicated staff time. A
few members of OIC staff noted that coordinating
volunteers across continents and time zones is
challenging and called for more in country staff.
Speech therapy volunteers from overseas have
to adjust to a new cultural context and may not
understand the cultural implications of OICs
project. They may not commit to more than a few
weeks of volunteering, which requires substantial
coordination with minimal benefit to OIC.
Organisationally, OIC needs administrative
and project management support as much as
professional speech therapy support. Many
activities recommended in this evaluation involve
analysing spreadsheets, checking documentation,
and maintaining strong lines of communication.
These can be done by in country volunteers or
staff and do not require speech therapy expertise.
Ideally, OIC should hire more local staff with
skills in administration, project management, and
monitoring and evaluation. If OIC does not have
the capacity to hire more local full-time staff, these
roles could be part-time or paid internships.
Be mindful of context and relationships when
expanding and scaling up
As discussed throughout, the outcomes of the
pilot are not generalisable across children with
disabilities in Cambodia. Many of the pilots
successes depended on the strong trust between
OIC and CABDICO. As the project expands,
OIC will have to invest significant resources into
understanding the needs and personalities of other
disability organisations. Expansion will also mean
new OIC staff. As discussed above, many new staff
members, both foreign and local, may not seem
to understand the needs and realities of partner
organisations.

In addition, pilot implementation focused in Siem


Reap province. While this evaluation discusses
Cambodian culture at length, culture is not
uniform, and environmental barriers, languages,
religions and cultural practices will likely need to
be accounted for in other provinces.
Account for training costs
OIC made an ethical decision to deliver all three
training sessions free of charge. OIC recognised
the high need for Cambodian speech therapy and
local organisations strict financial constraints.
This cost free training model not only prevents
the marginalisation of grassroots organisations,
but also builds goodwill and relationships
between them and OIC. Nevertheless, the financial
sustainability of OIC could be significantly strained
if the expanded training program remains free of
charge. These factors may be balanced by charging
a modest training fee, using a sliding scale that
accounts for organisations budgets.
Maintain adaptability
OIC grapples with a common problem of
generating enough financial support to
comprehensively implement the project. OIC has
not been able to support activities with the number
of people or work hours it knows would be more
effective. Nevertheless, OIC was fortunate that it
had few restrictions from its donors. This enabled
OIC to respond to learning as pilot implementation
unfolded. OIC was able to add additional training
and rethink its strategic plan. If OICs donor
portfolio expands, this will bring much needed
financial support to its project. However, OIC
should aim to maintain its flexibility and should
strive to avoid any overly burdensome donor
restrictions.
This can be achieved through a donor that
understands the ever changing nature of piloting
new work and is open to evaluation methods that
go beyond the traditional rigidity of counting
numbers. An evaluation method that prioritises
and rewards learning would be far more beneficial.

S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 41

6 Conclusion
Cambodian disability workers, like the one quoted
to the right, have worked with children with
communication and swallowing disabilities for
years without access to the skills they need to
address these disabilities. Many families are weary
after trying other treatments that did not work. The
demand for speech therapy is enormous. In 2014,
OIC effectively trialled a unique speech therapy
approach in Cambodia.
Through this approach, there have been significant
improvements in the lives of children with
disabilities despite resource constraints. Although
care needs to be taken in scaling up this approach,
this evaluation validates not only the need for
speech therapy, but also the model that can
address this need.
Significant challenges to successful implementation
remain, from the need to increase community
awareness of speech therapy to the lack of a
common Khmer speech therapy language. Pilot
expansion will require the coordinated efforts
of many sectors and organisations beyond
OIC and CABDICO to successfully address
the barriers currently preventing people with
communication and swallowing disabilities
from participating fully in society. However, this
coordinated approach will only work with the
support of funding bodies that recognise the value
of this service and the uncertainty that comes
with piloting a new program. Limited financial
resources are the key barriers restricting access to
speech therapy for the one in 25 Cambodians who
need it.
If OIC and its partners strengthen and nourish
their relationships, communicate well between
themselves, and document and analyse how
implementation really works in a Cambodian
context, then the projects capacity to address
Cambodias long overlooked communication and
swallowing needs will flourish.

I think speech and


communication is not just
changing the children but
changing the communication
behaviour, to start to connect
to each other, to make society
have bravery, to know how
to communicate, to love each
other, yes, its very good
speech therapy should have
come here longer ago It
should have come here six or
seven years ago when I first
started to work... (Laugh)
Why has it just arrived now?
- Disability worker -

42 | OIC: THE CAMBODIA PROJECT

References
Astbury, J. and Walji, F. (2013) Triple jeopardy:
Gender-based violence and human rights
violations experienced by women with disabilities
in Cambodia. AusAID Research Working Paper 1,
January 2013.
Evans, P., Shah, S., Huebner, A.,
Sivasubramaniam, S., Vuthy, C., Sambath, K.,
Haurisa, L., and Borun, Y. (2014) A Populationbased Study on the Prevalence of Impairment and
Disability Among Young Cambodian Children.
Disability, CBR and Inclusive Development, 25(2),
5-20.
Greenhalgh, T., Robert, G., Bate, P., Kyriakidou,
O., Macfarlane, F., and Peacock, R. (2004) How
to Spread Good Ideas: A systematic review of
the literature on diffusion, dissemination and
sustainability of innovations in health service
delivery and organisation. Report for National
Co-Ordinating Centre for NHS Service Delivery
and Organisation R&D. Retrieved from http://
www.cs.kent.ac.uk/people/staff/saf/share/greatmissenden/reference-papers/Overviews/NHS-litreview.pdf.
Mannan, H. and Turnbull, A.P. (2007) A Review
of Community Based Rehabilitation Evaluations:
Quality of Life as an Outcome Measure for Future
Evaluations. Asia Pacific Disability Rehabilitation
Journal, 29(18), 1-17.
Orthophonistes du Monde (ODM). (2014)
CABDICO-OdM Mission Report October 20th
31st October 2014.

Palisano et al. (1997) Development and reliability


of a system to classify gross motor function in
children with cerebral palsy. Developmental
Medicine and Child Neurology, 39:214-23
Paul, D. and Roth, F.P. (2011) Guiding Principles
and Clinical Applications for Speech-Language
Pathology Practice in Early Intervention.
Language, Speech, and Hearing Services in
Schools, 42, 320-330.
Thomas, M. and Yeang, B. E. (2012) Evaluation
of CABDICO Disability Programme, Cambodia.
Retrieved from http://cabdico.org/wp-content/
uploads/2014/01/CABDICO-ImpactEvaluation-2010.pdf.
VanLiet, B., Samol, C., and Prum, R. (2007)
Children with disabilities in rural Cambodia: An
examination of functional status and implications
for service delivery. Asia Pacific Disability
Rehabilitation Journal, 18(2), 33-48.
Wing, C. Kohnert, K., Pham, G., Cordero, K.N.,
Ebert, K.D., Kan, P.F., and Blaiser, K. (2007)
Culturally consistent treatment for late talkers.
Communication Disabilities Quarterly, 29(1), 20-27.
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S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 4 3

Appendices
Appendix A: Primary and secondary evaluation data
Appendix B: Family MSC stories
Appendix C: Follow-up book summaries
Appendix D: ODM training evaluations
Appendix E: Pre and post training staff questionnaires

44 | OIC: THE CAMBODIA PROJECT

SAMPLE SET

DATE
COLLECTED

DESCRIPTION

Disability Workers/Trainees
15 DWs from four organisations

20/1/14

Pre-training general ST knowledge questionnaire


Pre-training language questionnaire

??

??

CABDICO Knowledge test

11 DWs from three organisations

30/5/14

Post-training general ST knowledge questionnaire


Post-training language questionnaire

6 CABDICO trainees

2/15

Meeting 1 to clarify evaluation goals


Focus Group 1: a) key ST skills/attributes, and b) training in
collecting MSC data from families
Field visit with family to pilot MSC
Focus Group 2: a) MSC results, and b) implementation barriers
and facilitating factors
Field visit with family to observe basic ST treatment

3 CABDICO CROs

2/15

Interview on basic ST treatment

1 CABDICO manager

2/15

Interview on implementing project with OIC

28/1/14

Pre-training questionnaire
Post-training questionnaire

Interview regarding the most significant change in family quality


of life since basic ST treatment began

1 9 c a s e s t u d y c h i l d r e n w i t h 1/14
communication/ swallowing disorders
identified by CABDICO

Baseline data pre-SLT treatment for tracking as case study children

1 3 c a s e s t u d y c h i l d r e n w i t h 2/15
communication/ swallowing disorders

Full DW treatment documentation (follow up books) for case


study children currently receiving basic ST treatment.

??/5/14

Pre- and post- training questionnaire

Managing Director

2/15

Two interviews on pilot implementation and scaling up in future


phase

3 SLT Specialists

2/15

Interview on current ST needs in Cambodia, pilot implementations,


and scaling up in future phase

1 Strategy Advisor

2/15

Interview on scaling up, risk management, and using volunteers

n/a

2/15

Review of organisational documents (situational analysis, strategic


plan, budgets, etc.)

Parents/Families
19 Families of children with
communication/swallowing disorders

13 Families who have received basic ST 3-11/2/15


services from CABDICO DWs/trainees
Children

Teachers
29 Teachers
OIC Staff and Advisors

Appendix A: Primary and secondary evaluation data

BIRTH YEAR

CP

CP

CP

CP

CP

CP

2002 M

2007 M

2008 M

2012 M

2008 M

2005 M

MI 27

GENDER
DIAGNOSIS

2009 M

FAMILY
MEMBER
INTERVIEWED

Appendix B: Family MSC stories (continued next page)

Mother

Mother

Older
aunt

Mother

Mother

Mother

Mother

At first child has started with a few words until he can speak out a sentence.
Although his communication is improved, his voices is not so clear. He stop
coughing or stucking when he eat food, but he gets coughing only he does not
drink water through tube. His memory is better. The mother said the most
significant change is communication because I am so happy when my child can
debate or talk to his friends.

He can eat several kinds of food and he is not so often coughing. He can
communicate with others by body language. Parents are happy when he is
getting healthy so they have more time for income generation.

He can swallow in better way, for instance, not so often cough and stuck in the
throat. His family members are very happy when they see he is healthy. Now
he can turn his body over and he also be able to tell his needs by body language.
Lastly, he can position his neck.

Family happiness is happening while the child can speak more words and clearer
than before. For instance, parents could understand the child's needs. More
specifically, the child can eat both soft and hard food. And he has more friends
and they understand his communication. Right now, he can be far from his
mother.

He can speak the words he heard. He stop coughing when eating food. The
significant change is he can play with other children, for instance, he can visit his
neighbours alone because those people understand his words. His mother hope
that one day he can go to school.

The significant change is he can speak in better way and other people around him
understand his words. So he has more new friends. Last but not least the family
get more income and be closer.

Change in speaking since he has received the speech therapy. Before he was
often sick while now he is better. So he has changed a lot in speaking because his
mouth is not sticky. Moreover, he is getter easier to speak, especially parents are
happy when their child can go to school. In short, parents are happy when their
child's swallowing and communicating disorders is being solved from time to
time.

STORY

Better
Swallowing
X

Clearer
Speaking
X

Body
Language
X

Better
General
Health
X

School
X

Friends
X

Happy
family
X

Parents
have more
time

OUTCOMES REPORTED IN STORY


S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 4 5

BIRTH YEAR

Appendix B: Family MSC stories

CP

2008 M

CP

Cleft
Palate

2013 M

MI27

2004 M

CP

2009

Cleft
Palate

GENDER
DIAGNOSIS

2010 M

FAMILY
MEMBER
INTERVIEWED

Mother

Cousin

Father

Mother

Mother

Mother

Better
Swallowing

9
Total prevalence of outcomes in stories

Clearer
Speaking

Body
Language
X

School
3

Friends
4

Happy
family
5

Parents
have more
time

OUTCOMES REPORTED IN STORY



Better
General
Health

The child can swallow better, not too often cough and stuck. His body position is
improved. He is healthy. But his communication is growing slowly so the family
members are getting more responsibilities for take care of child.

The child can sit by himself. The most significant change, he can swallow better,
not too often cough and stuck. He is healthy. He can dress by himself. He can tell
his needs by body sign. Family members have more time to do other tasks.

The child can speak clearer and better than before, for instance, he can speak a
word that has two or three consonants. The most significant change, the child can
swallow easier and he can much more food. He is not coughing. Now parents
have more time to do other tasks.

Mother said, his voices is clearer than before so that she does not need to verify.
In regarding with swallowing is good. In short the family members are very
happy when the child can speak better. But there is only thing that they do not
happy with, the child cannot walk.

Mother is so happy when her child can communicate in basic way, for example,
he can communicate via body sign and face language. Moreover, he can sit . by
himself. From this improvements mother has more time to do other tasks because
she does not to be with him all the time.

The most significant change for him is that he can go to school because his voices
is assumed that is clear enough, for example, only one of ten words that is not so
clear while before ten words, that he speaks, are not clear at all. As the result, he
can do something by himself and he can tell about his needs. The most interesting
he can sing, and his sound is understandable, mother said.

STORY

46 | OIC: THE CAMBODIA PROJECT

It does not tell exactly how CRO


works with child. But it states the
results that the child can go to
school and his communication is
good.

CRO made a good documentation


with stating outcome of activity
(progress) between 10-2 and
10-6-2010 except the rest of time.
The result shows that he can walk
and go to school sometimes not
regularly.

In the future child


can go to school and
his communication
will be improved
so that his family
members and teacher
can communicate
with him

Child can sit and


walk by himself
in the next three
years and his
mother is able to
manage childs
daily activities and
development.

Case Study #4
Name: Kea Sochhy
Gender: M
DOB: 2005
Diagnosis: Mouth
Cleft
CRO: Chhien

Case Study #5
Name: Mao Morn
Gender: M
DOB: 2009
Diagnosis: CP
CRO: Simoun

Child can know


how to sit for
three months. For
three months child
can move his knee
with support of
his mother

For three months,


child can stand up
with support of
technical aids

It is done two times per month and


one time per month. It seems the
child has received services from
CRO, but it did not say the child can
walk. CRO provided technical aids
to child.

In the next three


years, child can walk
by himself and can
do his own daily
activities.

Case Study #3
Name: Houn Neang
Gender: M
DOB: 2007
Diagnosis: CP
CRO: Chhien

SHORT
TERM GOAL

During the first


three months,
child can stand
up by himself.
Child will only
sometimes cough
when eating and
drinking

Discusses health follow up - doesnt


tell whether referred to hospital or
not

FOLLOW UP

In the next three


It did not tell the result of rehab.
years, a child can
However, CRO has followed some
walk by himself. And of the short-term activities.
parents will be able
to help their child.

PLANNING

Case Study #2
Name: Hor Sreydav
Gender: F
DOB: 2011
Diagnosis: CP
CRO: Chhien

Case Study #1
Name: Bu Somnang
Gender: F
DOB: 2012
Diagnosis: Mouth
Cleft
CRO: Simoun

CASE STUDY

Prepare rehab equipment (three cornerschair). Follow up three times/month.


Teach his mother. Provide rehab services
and follow up three times/month

Discuss with family to prepare the rehab


premise. Teach child and his family
members on how to do self-rehab.
Assessment

Discuss with parents for rehab


preparation. Teach parents on how to
help child when eating and drinking, for
instance, drinking by tube.

ACTIVITIES

Starts 10/2/2010

Starts 21/1/14

Starts 20/7/2010

Starts 30/09/2012

Starts 18/3/2014

TIMEFRAME

S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 47

Appendix C: Follow-up book summaries (continued next page)

FOLLOW UP
In 2012 teaching child how to hold
pencil and model skills and nothing
state about communication. In 2014
discussion about childs study,
but it does not tell the child study
at school or just only at home.
Mentioning about language, but not
sure what language is. Providing
many technical aids and many
donor visits. It seems like she is not
really providing communication
therapy- doesnt have time.
CRO follows what set in the
short-term plan, but every activity
undertaken did not tell the result,
but based on the progress the child
can go to school.

CRO made a good follow up, but


she/he did not show the result.
So mainly, it is the problem with
documentation. Although, the TA
is developed, no results are shown
that the child can walk by himself
without supporting of TA or the
child can go to school.

PLANNING

Next year, the child


is being ready to go
to school. His mother
has ability to develop
the child.

Child will be able to


learn how to write at
home and go to study
at school

Plan in 2011: Child


can stand up with
supporting of
technical aids. He can
do daily tasks such as
eating, walking with
supporting of TA in
the next three years.
Parents will pay
much attention on
childs development
and childs
daily activities.
Plan in 2013: Child
can walk and go to
school by himself

CASE STUDY

Case Study #6
Name: Yon Socheat
Gender: M
DOB: 2005
Diagnosis: CP
CRO: Chhien

Case Study #7
Name: Theoun Thiv
Gender: F
DOB: 2004
Diagnosis: CP
CRO: Simoun

Case Study #8
Name: Ra Tai
Gender: F
DOB: 2009
Diagnosis: CP
CRO: ??

Prepare materials for preschool at home


and need to follow up three times/
month. Contact the school director for
registration.

ACTIVITIES

Mother will help


her child to do
knee exercise for
three months.
Chill has a small
play ground for
three months.
In 2013: Child can
get preschool at
home. In the next
three months child
can go to school

Discuss with parents and transfer


knowledge of movement strengthening
to mother. Provide Trolley Standing and
follow up three times/month. Purchase
rehab space (premise) with contribution
between family and CABDICO. In 2013:
Teach child to draw and write (CRO
follows up child's study three times per
month)

For three months


1. Prepare rehab equipment. Implement
child can write
rehab activity two times/month.
letter and number. 2. Discuss on study materials and a
For three months
bicycle. Contact school director and
child will be
key teacher to register the child.
registered at
Follow up two times/month
school

In the period of
three months,
child start learning
how to write and
in another three
months the child
can go to school.

SHORT
TERM GOAL

Starts 1/9/2011

Starts 8/2/2011.
For the Activity
1 takes between
2-7-2011. Activity
2 takes between
9-12-2011

Starts 26/2/2009

TIMEFRAME

48 | OIC: THE CAMBODIA PROJECT

Appendix C: Follow-up book summaries (continued next page)

FOLLOW UP
Keep records of activities such
as child development (social,
cognition, hearing, vision)
evaluation, medication history
from Angkors Children Hospital
and services (exercise, discuss with
parents to make technical aids) by
CABDICO. Staff start using skills
from ST training to access the
swallowing ability of child
There is no clear connection
between an activity to another one
in 2011. But more clear connection
in 2014. DW focusing more the
goal the child goes to school and
achieved goal. It does not tell the
missing activity is done in another
period of time. Moreover, their
notes are not clear enough for other
people to read.

CRO made good points. She kept


a good record of undertaken
activities. She stated the result of
every activity. There is a change on
child. He can go to school.

PLANNING

A child can walk


round trips with
support of technical
aids for 20m for two
times/day and three
times/day in the
next three years.

A child will walk by


himself around the
house and further
from house. Also he
will go to school by
himself in the next
three years.

Child will be able


to walk and can do
daily activities by
himself. The child
will go to school. The
family members will
support his activities.

Case Study #9
Name: Chheoun
Reaksmey
Gender: M
DOB: 2002
Diagnosis: CP
CRO: Phearom

Case Study #10


Name: Keo Ruon
Gender: M
DOB: 2009
Diagnosis: CP
CRO: Phearom

Case Study #11


Name: Uk Lin
Gender: M
DOB: 2001
Diagnosis: CP
CRO: Phearom

CASE STUDY
Gross motor, playing game and exercise

ACTIVITIES

His family
members will
understand the
core activities of
CABDICO. Child
will be able to
walk. He will
dress by himself.
He can speak out
a sentence. He
can position his
arm. Child can
write and be able
to draw a circle.
Child will have
strong confident
in study. Child
will know how to
tell his own needs.

Orientation on CABDICO. Verbal


explanation on picture of disabled
children. Do finger exercise. Teach how
to dress. Arm and foot exercise. Teach
the child how to hold pen. Assist child
in school registration and explain the
disability conditions that child has. And
raise awareness on disability in school.
Voice exercise (1-6-2014) to find out voice
that he cannot say out. Mouth muscle
exercise and body sign exercise (6-12
2014)

Child can walk


Games, pictures, muscle exercise (back
by hands for 5m
and foot), provide pillow to support.
then 8m. Child
Provide preschool orientation.
can stand by
using knees for
ten minutes. Child
can walk around
house. Child can
speak a word and
child can start
kindergarten class.

A child can sit


and eat food by
himself. He can
stand up with
the support of
technical aids.

SHORT
TERM GOAL

Starts 7/6/2009

Starts 29/1/2011

Starts 27/7/2013

TIMEFRAME

S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 4 9

Appendix C: Follow-up book summaries

Appendix D: ODM training evaluations (continued next page)

positioning
for eating and
drinking

3 - sitting in the right form


while eating / correct posture
for eating and drinking /
effectiveness of swallowing
food

2 - suck
and swallow
for infant
(interesting for
hospital staff)

I want to learn
more about
speech therapy

4 - speech therapy
3 / definition
and using speech
therapy and those
who receive speech
therapy

3 - speech therapy

4 - Yes / yes
it will change
/ I think
there will be a
change / yes,
definitely!

CHANGE
WORK

exercise for
stimulate
suck and
swallow

XX

communication communication

swallowing

NEW
TOPIC

2 - pronunciation X X
(for teaching
children)
listening testing,
listening sound

3 - Pronunciation
(vowel and
consonant)

6 - Pronunciation (vowel and


consonant

communication

swallowing

WOULD
LIKE MORE

4 - hearing (listening) 2 /
hearing loss / hearing devices

3 - communication
(good habit)

3 - swallowing (how
to treat issues)

TOPICS MOST
IMPORTANT

7 - communication (good habit)


6 / communication language

7 - swallowing / helping
children with speak and
swallowing difficulty / how
to effectively help a child with
swallowing trouble / helping
children with speak and
swallowing difficulty / how
to effectively help a child with
swallowing troubles / how to
speak and swallow

SKILLS LEARNED

for sucking
and
swallowing
next
training

Should be
more new
topics or
courses
regarding
speech
therapy

BARRIERS OTHER

want more speech therapy


for staff

Communication disorder
and unclear and misspelled
speaking

(Hosp) Communication
and swallowing disorders
can affect anyone with
neurological problems,
so taking part in "normal
society life" is very difficult
or not possible for them.
Difficulties eating and
understanding and making
oneself understood

difficulty in swallowing,
choking while eating and
food falling from mouth
/ communication and
swallowing disorders have
resulted from giving food
or fluid and timing are not
consistent with each other

YOUR
UNDERSTANDING

50 | OIC: THE CAMBODIA PROJECT

stuttering

2 - stuttering

assistive devices;
adapted devices

assistive devices

stimulation games

1 - testing

1 - stimulation game

Practical
implementation
with children

sound disorders,
how to identify
sound

visiting
children
teaching signs

voice
expression /
good speaking
habit

WOULD
LIKE MORE

2 - how to identify sound


/ using sound with words,
characters and vowels

2 - intensity, frequency

sign development

voice expression

2 - what is voice?

2 - using signs / sign


language

vocal system

TOPICS MOST
IMPORTANT

3 - language (disorders, use)

SKILLS LEARNED

want this skill


to be existed in
Cambodia

Intervening for
children with
speaking and
swallowing
difficulties

NEW
TOPIC

It's easier to
understand
and to work
with children
having speech
therapy

Know better
on how to
express voice

CHANGE
WORK

high
workload /
many fields
of works
that we
need to be
responsible

would be
interesting
for staff of
the hospital
to maybe
join shorter
workshops
(about five
days) since
it's not easy
for them to
get off work
altogether.

BARRIERS OTHER

Communication and
swallowing disorders
are important issues in
Cambodia, particularly
they happened with
small children. I do hope
that CABDICO will keep
continue to provide more
training to professional
staff so that they could
be able to intervene
directly with children with
disabilities

help me to know about how


to process and intervention
and evaluation

It's hard to understand and


the pronunciation from
each consonant is difficult
with the sign

use of materials and food


is too selective

communication and
swallowing disorders are
resulted from varieties of
disabilities

YOUR
UNDERSTANDING

S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 5 1

Appendix D: ODM training evaluations (continued next page)

hearing loss

3 - making toys and


how to play, create
communication,
language and
pronunciation /
activities to help
get students to
communicate
/ playing with
children with
disabilities

1 - impact of hearing; multisensual hearing, volume


hearing

1 - how to play with children


and make toys

benefit of basic
experiment on
child's growth

hearing system
(ear)

WOULD
LIKE MORE

1 - difference between language, body language and


sounds, communication, speaking spoken language
activities

1 - game development and 2 - game development 2 - development


methodology
(and methodology)
of game

demonstration of
hearing impact,
particularly
demonstration of
level of volume
(voice) that can
affect the ears

TOPICS MOST
IMPORTANT

1 - listening system (ear)

SKILLS LEARNED

how to play
with children;
definition
of effective
activities for
playing with
children

details of
impact of
hearing loudly

NEW
TOPIC

(know better)
develop game
for children

yes I do, as
it helps us
to be more
confident
in helping
children
as well as
ways to
communicate
with the
family more
effectively

CHANGE
WORK

No

did not
practice
with
children

lack of
expert/
professional
nearby

BARRIERS OTHER

disorder has resulted from


unclear information

how to define for playing


with children directly;
how to define for finding
objective or reason to play
with children

(teacher) Communication:
difficult to make
connections in head if do
not know the vocabularymaking links between
things; there are specific
techniques you can use to
help children who have
trouble swallowing. It
is harder to get specific
nutrients

YOUR
UNDERSTANDING

52 | OIC: THE CAMBODIA PROJECT

Appendix D: ODM training evaluations (continued next page)

1 - techniques and skill to use


with my students

SKILLS LEARNED

TOPICS MOST
IMPORTANT

2 - specifically
with autistic
children

WOULD
LIKE MORE

specific tactics
with specific
disabilities/
impairment

want more
trainings;
should have
more refresher
trainings /
wish to have
an in-depth
lesson on each
training

NEW
TOPIC

after training,
all topics
or courses
will be the
experiences at
community

I have a
change after
attending
ten-day
training; I
feel that, after
attending
this course, I
gained more
knowledge
than before

CHANGE
WORK

2 - lack of
confidence

4 - lack
of skills 2
/ I have
difficulty as
I don't have
clear skill to
work with
children /
still have
difficulty
as I don't
receive skill
quite well

(teacher)
not a lot of
professional
support,
not a lot of
guideline

4 - wish to
have more
training in
the future 2
/ need more
training in
the future
/ don't be
rush with
too many
topics

BARRIERS OTHER
should provide this
training for teachers in the
community

YOUR
UNDERSTANDING

S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 5 3

Appendix D: ODM training evaluations

54 | OIC: THE CAMBODIA PROJECT

SAMPLE SET

NEVER LITTLE OF SOMETIMES NEARLY


THE TIME
ALWAYS

I feel confident in identifying ST


problems in the children I see

ALWAYS

CHANGE
-1

I feel confident in knowing


how to help children with ST
problems communication better

I know the rights activities to


use to help children with ST
problems communication better

I know where to find


information about ST problems

I know what to advice parent


and care taker of children with
ST problems

I feel confident that I can


emotionally support parent and
care taker of children with ST
problems

I understand the different type


of ST problems children may
experience

I know how to plan short-term


goals for children with ST problems

I know how to plan long-term


goals for children with ST problems

I know how to evaluate whether


my ST work with the children and
their families is successful

2
+9

X - response to pre-questionnaire 27 Dec 2013


X - response to pre-questionnaire 30 May 2014

Appendix E: Pre and post training staff questionnaires (continued next page)

S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 5 5

SAMPLE SET

NEVER LITTLE OF SOMETIMES NEARLY


THE TIME
ALWAYS

I feel confident in identifying ST


problems in the children I see

ALWAYS

CHANGE
0

I feel confident in knowing


how to help children with ST
problems communication better

-1

I know the rights activities to


use to help children with ST
problems communication better

-1

I know where to find


information about ST problems

I know what to advice parent


and care taker of children with
ST problems

-1

I feel confident that I can


emotionally support parent and
care taker of children with ST
problems

I understand the different type


of ST problems children may
experience

-1

I know how to plan short-term


goals for children with ST problems

I know how to plan long-term


goals for children with ST problems

I know how to evaluate whether


my ST work with the children and
their families is successful

2
+2

X - response to pre-questionnaire 27 Dec 2013


X - response to pre-questionnaire 30 May 2014

Appendix E: Pre and post training staff questionnaires (continued next page)

56 | OIC: THE CAMBODIA PROJECT

SAMPLE SET

NEVER LITTLE OF SOMETIMES NEARLY


THE TIME
ALWAYS

I feel confident in identifying ST


problems in the children I see

ALWAYS

CHANGE
0

I feel confident in knowing


how to help children with ST
problems communication better

I know the rights activities to


use to help children with ST
problems communication better

I know where to find


information about ST problems

I know what to advice parent


and care taker of children with
ST problems

I feel confident that I can


emotionally support parent and
care taker of children with ST
problems

I understand the different type


of ST problems children may
experience

I know how to plan short-term


goals for children with ST problems

I know how to plan long-term


goals for children with ST problems

I know how to evaluate whether


my ST work with the children and
their families is successful

1
+12

X - response to pre-questionnaire 27 Dec 2013


X - response to pre-questionnaire 30 May 2014

Appendix E: Pre and post training staff questionnaires (continued next page)

S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 5 7

SAMPLE SET

NEVER LITTLE OF SOMETIMES NEARLY


THE TIME
ALWAYS

I feel confident in identifying ST


problems in the children I see

ALWAYS

CHANGE

-2

I feel confident in knowing


how to help children with ST
problems communication better

I know the rights activities to


use to help children with ST
problems communication better

I know where to find


information about ST problems

-1

I know what to advice parent


and care taker of children with
ST problems

I feel confident that I can


emotionally support parent and
care taker of children with ST
problems

I understand the different type


of ST problems children may
experience

-1

I know how to plan short-term


goals for children with ST problems

I know how to plan long-term


goals for children with ST problems

I know how to evaluate whether


my ST work with the children and
their families is successful

0
-2

X - response to pre-questionnaire 27 Dec 2013


X - response to pre-questionnaire 30 May 2014

Appendix E: Pre and post training staff questionnaires (continued next page)

58 | OIC: THE CAMBODIA PROJECT

SAMPLE SET

NEVER LITTLE OF SOMETIMES NEARLY


THE TIME
ALWAYS

ALWAYS

CHANGE

I feel confident in identifying ST


problems in the children I see

I feel confident in knowing


how to help children with ST
problems communication better

I know the rights activities to


use to help children with ST
problems communication better

I know where to find


information about ST problems

I know what to advice parent


and care taker of children with
ST problems

I feel confident that I can


emotionally support parent and
care taker of children with ST
problems

I understand the different type


of ST problems children may
experience

I know how to plan short-term


goals for children with ST problems

I know how to plan long-term


goals for children with ST problems

I know how to evaluate whether


my ST work with the children and
their families is successful

0
+10

X - response to pre-questionnaire 27 Dec 2013


X - response to pre-questionnaire 30 May 2014

Appendix E: Pre and post training staff questionnaires (continued next page)

S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 5 9

SAMPLE SET

NEVER LITTLE OF SOMETIMES NEARLY


THE TIME
ALWAYS

I feel confident in identifying ST


problems in the children I see

ALWAYS

CHANGE
0

I feel confident in knowing


how to help children with ST
problems communication better

I know the rights activities to


use to help children with ST
problems communication better

I know where to find


information about ST problems

I know what to advice parent


and care taker of children with
ST problems

I feel confident that I can


emotionally support parent and
care taker of children with ST
problems

I understand the different type


of ST problems children may
experience

I know how to plan short-term


goals for children with ST problems

I know how to plan long-term


goals for children with ST problems

I know how to evaluate whether


my ST work with the children and
their families is successful

0
+5

X - response to pre-questionnaire 27 Dec 2013


X - response to pre-questionnaire 30 May 2014

Appendix E: Pre and post training staff questionnaires (continued next page)

60 | OIC: THE CAMBODIA PROJECT

Other organisations
SAMPLE SET

NEVER LITTLE OF SOMETIMES NEARLY


THE TIME
ALWAYS

I feel confident in identifying ST


problems in the children I see

I feel confident in knowing


how to help children with ST
problems communication better

I know the rights activities to


use to help children with ST
problems communication better

ALWAYS

CHANGE

-4

-1

I know where to find


information about ST problems

-3

I know what to advice parent


and care taker of children with
ST problems

I feel confident that I can


emotionally support parent and
care taker of children with ST
problems

-2

-1

I understand the different type


of ST problems children may
experience

-2

I know how to plan short-term


goals for children with ST problems

-2

I know how to plan long-term


goals for children with ST problems

I know how to evaluate whether


my ST work with the children and
their families is successful

0
-15

X - response to pre-questionnaire 27 Dec 2013


X - response to pre-questionnaire 30 May 2014

Appendix E: Pre and post training staff questionnaires (continued next page)

S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 6 1

SAMPLE SET

NEVER LITTLE OF SOMETIMES NEARLY


THE TIME
ALWAYS

I feel confident in identifying ST


problems in the children I see

I feel confident in knowing


how to help children with ST
problems communication better

ALWAYS

CHANGE
0

I know the rights activities to


use to help children with ST
problems communication better

I know where to find


information about ST problems

I know what to advice parent


and care taker of children with
ST problems

I feel confident that I can


emotionally support parent and
care taker of children with ST
problems

-2

I understand the different type


of ST problems children may
experience

-1

I know how to plan short-term


goals for children with ST problems

-1

I know how to plan long-term


goals for children with ST problems

-1

I know how to evaluate whether


my ST work with the children and
their families is successful

-1
-4

X - response to pre-questionnaire 27 Dec 2013


X - response to pre-questionnaire 30 May 2014

Appendix E: Pre and post training staff questionnaires (continued next page)

62 | OIC: THE CAMBODIA PROJECT

SAMPLE SET

NEVER LITTLE OF SOMETIMES NEARLY


THE TIME
ALWAYS

I feel confident in identifying ST


problems in the children I see

ALWAYS

CHANGE

-3

I feel confident in knowing


how to help children with ST
problems communication better

I know the rights activities to


use to help children with ST
problems communication better

-4

I know where to find


information about ST problems

-4

I know what to advice parent


and care taker of children with
ST problems

-3

I feel confident that I can


emotionally support parent and
care taker of children with ST
problems

-2

I understand the different type


of ST problems children may
experience

-4

I know how to plan short-term


goals for children with ST problems

-4

I know how to plan long-term


goals for children with ST problems

I know how to evaluate whether


my ST work with the children and
their families is successful

0
-24

Summary of changes in responses


9 + 2 + 12 + (-2) +10 + 5 + (-15) + (-4) + (-24)
= -7

X - response to pre-questionnaire 27 Dec 2013


X - response to pre-questionnaire 30 May 2014

Appendix E: Pre and post training staff questionnaires (continued next page)

OIC: The Cambodia Project

#296, St. 271 (Yothapol Khemarak Phoumin Blvd)


Sangkat Toul Tom Pong 2, Khan Chamkarmon
Phnom Penh, Cambodia
www.oiccambodia.org

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