Project Summary: Measuring what happens in voice therapy: refinement and testing of a voice therapy taxonomy The current healthcare landscape demands that medical interventions have strong empirical evidence to guide clinically effective treatment selection and delivery. For many medical treatments that deliver interventions to a passive patient (such as medications or surgery), clinical trials and comparative effectiveness research can describe, measure, and compare treatment ingredients in terms of changes in outcomes. However, currently the treatment ingredients contained in complex behavioral interventions (e.g. voice therapy approaches) are not specified in enough detail to be defined, measured, and compared with outcomes. This is a critical barrier to the progress of all behaviorally based medical professions. The fields of rehabilitation and psychology have invested considerable effort towards the development of treatment specification systems (i.e., taxonomies). While these expansive efforts have provided useful theories and overarching specification models, a gap remains between the theoretical frameworks and the clinicians/researchers who need a taxonomy detailed enough for use in their own subfield (e.g., voice therapy). A taxonomy of voice therapy can help fill this serious deficiency by providing a valid and reliable list/categorization structure of treatment ingredients. The proposed work is designed to refine a beta version of the Voice Therapy Taxonomy through development of consensus amongst 10 voice therapy experts in three Delphi rounds (face and content validity), creation of electronic documentation software based on the refined voice therapy taxonomy, and establish inter-rater reliability through specification of real-life voice therapy at five different Voice Centers. Input from rehabilitation stakeholders will include external readers (the primary investigator of PCORI?s Rehabilitation Treatment Taxonomy (RTT) [Dr. John Whyte] and an internationally recognized speech pathologist from the American Speech-Language-Hearing Association?s (ASHA) Treatment Taxonomy Ad-hoc Committee [Dr. Joseph Duffy]) as well as an Advisory Board consisting of the RTT executive committee. To obtain input from clinical stakeholders, the Advisory Board will also include expert clinicians: a speech pathologist representing the ASHA Special Interest Group on Voice (Dr. Rita Patel), and an laryngologist representing the American Broncho-Esophagological Association (Dr. James Burns).