Challenges inherent in optimizing speech-language pathology outcomes: it's not just about counting the hours.

Determining the optimal amount of intervention is possibly the biggest challenge facing speech-language pathologists (SLPs) today. Baker (2012) has provided an erudite and pithy summary of the relevant literature in the field of optimizing intervention outcomes, and proposed a conceptual framework to measure all the inputs and acts that may contribute to the algorithm of intervention intensity. In the following article, two issues are discussed: first, that the use of technological advances to increase intensity should focus on everyday communication outcomes and, secondly, that measuring the effects of treatments which aim to increase intensity should include the perceptions of the client. Describing the evidence-based kernels underlying treatment success is a complex endeavour, particularly when the target treatment outcome is improved conversation. A recent qualitative study is described where clients with brain injury and their families were asked about their perceptions of a communication partner training program, to help determine which part of the treatment worked and why. It is argued that such an approach may provide important information regarding the "active ingredients" of treatment success.