American Speech-Language-Hearing Association Functional Assessment of Communication Skills for adults (ASHA-FACS)

Evidence Reviewed as of before: 26-11-2010
Author(s): Sabrina Figueiredo, BSc
Editor(s): Lisa Zeltzer, MSc OT; Nicol Korner-Bitensky, PhD OT

Purpose

The ASHA-FACS is a measure of functional communication. It does not aim to measure impairment. Rather, the assessment aims to measure how specific speech, language, hearing and/or cognitive deficits affect the performance of daily life activities (Frattali, Holland, Thompson, Wohl, & Ferketic, 1995).

In-Depth Review

Purpose of the measure

The ASHA-FACS is a measure of functional communication. It does not aim to measure impairment. Rather, the assessment aims to measure how specific speech, language, hearing and/or cognitive deficits affect the performance of daily life activities (Frattali, Holland, Thompson, Wohl, & Ferketic, 1995).

Available versions

The ASHA-FACS was developed in 1995 by Frattali, Holland, Thompson, Wohl, and Ferketic.

Features of the measure

Items:
The ASHA-FACS consists of 43 items. The items within the ASHA-FACS address four domains: social communication; communication of basic needs; reading, writing and number concepts; and daily planning. It covers different activities of daily living (ADLs) such as understanding television and radio, responding in an emergency, and using a calendar (Frattali et al., 1995).

The ASHA-FACS is also subdivided into 2 scales: Communicative Independence and Qualitative Dimensions of Communication. These scales measure the level of independence, and the nature of the functional deficit, respectively (Frattali et al., 1995).

The ASHA-FACS is in an observational format, and requires that the examiner be familiar with the client prior to rating his/her communication. A major strength of the ASHA-FACS is that it has simple wording and behavioral operationalization of item content (Glueckauf, Blonder, Ecklund-Jonhson, Maher, Crosson & Gonzalez-Rothi, 2003).

The examiner can also solicit judgments from the significant others, in order to augment his/her observations (Frattali et al., 1995). It has been recommended that three observational sessions are required before ratings are made (Worrall & Yiu, 2000).

Scoring:
The items are rated after observing functional communication on the two scales.

The Communicative Independence Scale is rated on a 7-point scale ranging from 1) “does not perform the behavior” to 7) “does perform the behavior”. It reflects the extent of assistance the individual requires to perform routine verbal and nonverbal transactions. The Qualitative Dimensions of Communication Scale is rated on a 5-point scale reflecting adequacy, appropriateness, and promptness of communication and communication sharing.

The total score is obtained by summing the scores on each item and then dividing by the number of items (means). It is also possible to calculate both abovementioned scale scores by calculating the means of interest (Frattali et al., 1995).

Lower scores are indicative of greater impairment.

Time:
The ASHA-FACS takes, on average, 20 minutes to score. Administration will vary according to the time spent on the observational sessions (Frattali et al., 1995).

Subscales:
The ASHA-FACS is comprised of 2 subscales (Frattali et al., 1995):
– Communicative Independence
– Qualitative Dimensions of Communication

Equipment:
Not reported.

Training:
Not reported.

Alternative forms of the ASHA-FACS

None.

Client suitability

Can be used with:

  • Clients with stroke.
  • Clients with communicative deficits.

Should not be used in:

  • The ASHA-FACS should not be used with clients that are not able to communicate.

In what languages is the measure available?

English (Frattali et al., 1995)

Summary

What does the tool measure?

The ASHA-FACS is a measure of functional communication.

What types of clients can the tool be used for?

The ASHA-FACS can be used with, but is not limited to clients with stroke.

Is this a screening or assessment tool?

Assessment

Time to administer

The ASHA-FACS takes approximately 20 minutes to administer

Versions

None

Other Languages

English

Measurement Properties

Reliability

– One study examined the internal consistency of the ASHA-FACS and reported that, after deleting items with low correlations, all the other items scores and domain scores correlated well with the overall score.
– One study examined the intra-rater reliability of the ASHA-FACS and reported excellent reliability using Pearson correlations.
– One study examined the inter-rater reliability of the ASHA-FACS and reported excellent reliability using Pearson correlations.

Validity

Content
– One study examined the content validity of the ASHA-FACS and reported the ASHA-FACS items are representative of the everyday communication of older individuals in Australia.

Construct:
Convergent validity:
– Two studies examined the convergent validity of the ASHA-FACS and reported excellent correlations between the social communication domain of the ASHA-FACS and the FOQ; moderate correlations between the ASHA-FACS and Western Aphasia Battery, SCATBI, the communication domain of the Functional Independence Measure, the Rancho Los Amigos Levels of Cognitive Functioning and poor correlations between the ASHA-FACS and the SF-36.

Known Groups:
– One study examined known groups validity of the ASHA-FACS using Wilcoxon W and reported that the ASHA-FACS is able to discriminate between healthy individuals and those with communicative impairments.

Floor/Ceiling Effects

No studies have examined floor/ceiling effects of the ASHA-FACS in clients with stroke.

Sensitivity/ Specificity

– One study examined the sensitivity/specificity of the ASHA-FACS by comparing it with the Aphasia Checklist Score, as the gold standard and reported that a cut-off of 6.99 in the Communication Independence domain yields a sensitivity of 90% and a specificity of 70% while a cut-off of 4.81 in the Communications Dimensions yields a sensitivity of 100% and a specificity of 90%.

Does the tool detect change in patients?

No studies have examined the responsiveness of the ASHA-FACS in clients with stroke.

Acceptability

Examiners must have adequate opportunity for direct observation of communication at home or in the community. Additional information, as required, may be obtained from the significant other.

Feasibility

The administration of the ASHA-FACS is quick and simple.

How to obtain the tool?

The ASHA-FACS can be purchased from the ASHA website: http://www.asha.org/eWeb/OLSDynamicPage.aspx?Webcode=olsdetails&title=Functional+Assessment+of+Communication+Skills+for+Adults+(ASHA+FACS)

Psychometric Properties

Overview

We conducted a literature search to identify all relevant publications on the psychometric properties of the ASHA-FACS in individuals with stroke. We identified 5 studies.

Floor/Ceiling Effects

No studies have reported floor or ceiling effects of the ASHA-FACS in clients with stroke.

Reliability

Internal Consistency:
Frattali, Holland, Thompson, Wohl, and Ferketic (1995) verified the internal consistency of the ASHA-FACS in 32 subjects with stroke and 26 with traumatic brain injury. Items with correlations lower than 0.70 were deleted. All the other item scores and domain scores correlated well with the overall score.

Intra-rater:
Frattali et al. (1995) analyzed the Intra-rater reliability, as calculated using Pearson Correlation Coefficient, was excellent (r = 0.99).

Inter-rater:
Frattali et al. (1995) evaluated the inter-rater reliability of the ASHA-FACS. Speech language pathologists from five different centers throughout the US evaluated 32 subjects with stroke and 26 with traumatic brain injury. Inter-rater reliability, as calculated using Pearson Correlation Coefficient, was excellent (r = 0.82).
Note: the exact number of therapists was not provided.

Validity

Content

Davidson, Worral and Hickson (2003) analyzed the content validity of the ASHA-FACS among 30 older Australians (15 with stroke and aphasia and 15 healthy individuals). This observational study reported that the ASHA-FACS items are representative of the everyday communication of older individuals in Australia.

Criterion

Concurrent:
No studies have reported the concurrent validity of the ASHA-FACS in clients with stroke.

Predictive:
No studies have reported the predictive validity of the ASHA-FACS in clients with stroke.

Sensitivity/ Specificity:
Ross and Wertz (2004) estimated the sensitivity and specificity of the ASHA-FACS by comparing it with the Aphasia Checklist Score (Ross and Wertz, 2004), as the gold standard, in 10 clients with stroke and aphasia. The aphasia checklist score is a diagnostic test that takes into account information collected from the medical records and the World Health Organization’s concepts of disability. In the Communication Independence scale a cut-off of 6.99 yielded a sensitivity of 90% and a specificity of 70%. In the Communications Dimensions scale a cut-off of 4.81 produced 100% sensitivity and 90% specificity.

Construct

Convergent/Discriminant:
Frattali et al. (1995) assessed the construct validity of the ASHA-FACS by comparing it to the Western Aphasia Battery (Kertesz, 1982), the Scales of Cognitive Ability for Traumatic Brain Injury (SCATBI) (Adamovich & Henderson, 1992), and the communication domain of the Functional Independence Measure (FIM) (Keith, Granger, Hamilton, & Sherwin, 1987) and the Rancho Los Amigos Levels of Cognitive Functioning (Hagen, Malkmus, & Durham, 1972) in 32 subjects with stroke and 26 with traumatic brain injury. Correlations between the ASHA-FACS and all outcome measures were adequate.
Note: the authors did not report the correlation values.

Glueckauf, Blonder, Ecklund-Jonhson, Maher, Crosson and Gonzalez-Rothi (1993) assessed correlations between the scores of the ASHA-FACS, the Western Aphasia Battery (Kertesz, 1982), the Functional Outcome Questionnaire for Aphasia (FOQ-A) (Glueckauf et al., 1993) and the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) (Ware & Sherbourne, 1992). All outcome measures were scored by 18 caregivers of individuals with stroke. Correlations were found to be excellent between the social communication domain of the ASHA-FACS and the FOQ-A (r = 0.74) and poor between this domain and the Aphasia Quotient of the Western Aphasia Battery and the SF-36 (r = 18; r = 0.19, respectively). Correlations between the basic needs domain of the ASHA-FACS and the FOQ-A were adequate (r = 0.58), while correlations between the basic needs domain of the ASHA-FACS and the Aphasia Quotient of the Western Aphasia Battery and the SF-36 were poor (r = -16; r = 0.14), respectively.

Known groups:
Ross and Wertz (2003) verified the ability of the ASHA-FACS to discriminate between healthy elderly individuals (n = 18) and individuals who had experienced stroke and mild aphasia (n = 18). Known groups validity, as calculated using Wilcoxon W, suggested that scores of healthy subjects were significantly higher than the scores of the participants with verbal communicative impairments. Therefore, the ASHA-FACS is able to differentiate between healthy individuals and individuals with mild aphasia.

Responsiveness

No studies have reported the responsiveness of the ASHA-FACS in clients with stroke.

References

  • Adamovich, B.B. & Henderson, J. (1992). SCATBI – Scales of Cognitive Ability of Traumatic Brain Injury. Riverside.
  • Blomert, L., Kean, M. L., Koster, C., & Schokker, J. (1994). Amsterdam-Nijmegen Everyday Language Test: construction, reliability and validity. Aphasiology, 8, 381-407.
  • Davidson, B., Worrall, L., & Hickson, L. (2003). Identifying the communication activities of older people with aphasia: Evidence from naturalistic observation. Aphasiology, 17, 243-264.
  • Frattali, C. M., Thompson, C. K., Holland, A. L., Wohl, C., & Ferketic, M. M. (1995). The FACS of Life. ASHA FACS — A Functional Outcome Measure for Adults. ASHA, 7, 40-46.
  • Glueckauf, R. L., Blonder, L. X., Ecklund-Jonhson, E., Maher, L., Crosson, B., & Gonzalez-Rothi, L. (2003). Functional questionnaire for aphasia: overview and preliminary psychometric evaluation. Neurorehabilitation, 18, 281-290.
  • Hagen, C., Malkmus, D., & Durham, P. (1972). Rancho Los Amigos Levels of Cognitive Functioning. Communication Disorders Service: Rancho Los Amigos Hospital.
  • Keith, R. A., Granger, C. V., Hamilton, B. B., Sherwin, F. S. (1987). The functional independence measure: A new tool for rehabilitation. Adv Clin Rehabil, 1, 6-18.
  • Kertesz, A. (1982). Western Aphasia Battery. NY: Grune & Stratton.
  • Ross, K. B. & Wertz, R. T. (2003). Discriminative validity of selected measures for differentiating normal from aphasic performance. American Journal of Speech-Language Pathology, 12, 312-319.
  • Ross, K. B. & Wertz, R. T. (2004). Accuracy of formal tests for diagnosing mild aphasia: An application of evidence-based medicine. Aphasiology, 18, 337-355.
  • Ware, J. E. Jr. & Sherbourne, C. D. (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care, 30, 473-483.
  • Worrall, L. & Yiu, E. (2000). Effectiveness of functional communication therapy by volunteers for people with aphasia following stroke. Aphasiology, 14, 911-924.

See The Measure

How to obtain the ASHA-FACS:

The ASHA-FACS can be purchased at the ASHA website and costs $USD165 for a certified non-ASHA member, and $USD124 for an ASHA member. This price does not include taxes and shipping.

Following is the website address for purchasing the ASHA-FACS: https://www.asha.org/

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