The Impact of Racism, Power, Privilege, and Positionality on Communication Sciences and Disorders Research: Time to Reconceptualize and Seek a Pathway to Equity

'We know the lack of services': Service lead's perspective of enablers and barriers to hearing assessment for children in metropolitan, regional and rural Australia: A qualitative study

OBJECTIVE

To explore potential enablers and barriers to accessing paediatric hearing assessment from the perspective of Australian service leads, extending previous studies on this topic from the perspectives of two other stakeholder groups - parents and speech pathologists.

DESIGN

This qualitative study, expanding upon previous mixed-methods studies, applied a pragmatism paradigm.

SETTING

The study was undertaken online via Zoom and included participants who were service leads of organisations that offer hearing assessment in metropolitan, regional, rural and remote parts of Australia.

PARTICIPANTS

Eight Australian service leads participated in semi-structured interviews.

RESULTS

Barriers identified were similar to barriers in previous studies. Three main themes were identified. First, children with hearing loss in Australia are well identified at birth. The second theme focused on the reduced and inconsistent hearing assessment services available after this age. Finally, service leads discussed the importance of embracing technology to solve service access difficulties.

CONCLUSION

Consultation with key stakeholders, to consider the needs of different communities within Australia, will be crucial when identifying new service delivery options.

Consideration of Demographic Variables in Behavioral Interventions Pertaining to Children With Hearing Loss: A Systematic Review

PURPOSE

Equitable representation of children with hearing loss who are members of marginalized or minority groups in behavioral intervention studies enhances inclusivity in the scientific process and generalizability of results. The goal of this systematic review was to ascertain the percentage of studies conducted in the United States in the past 2 decades that reported relevant demographic variables.

METHOD

Studies were searched across eight databases and clinical trial registries in October 2022. Variations of the following search strings were used to retrieve peer-reviewed published studies and unpublished clinical trials: children, hearing loss, and intervention.

RESULTS

Thirty-nine intervention studies met the inclusion criteria. The selected studies were reviewed and coded for the following demographic variables: area and type of intervention, participant age, hearing technology data, sample size, gender, race/skin color and ethnicity, primary/home language(s), additional disabilities, parental education, family income, and parental occupation. Results revealed that many demographic variables were remarkably underreported, with parental education, family income, and parental occupation variables being the least reported data.

CONCLUSIONS

Demographic data can be an important tool for changing disparities related to intervention outcomes. This systematic review suggests that inclusive research practices should be extended to low-literacy or low-economic resources, non-White, and non-English-speaking groups. Inclusion practices coupled with sufficient sample sizes will ultimately aid in identifying hearing health disparities.

Diversity of Research Participant Gender, Race, and Ethnicity in Communication Sciences and Disorders: A Systematic Review and Quantitative Synthesis of American Speech-Language-Hearing Association Publications in 2020

Purpose

One manifestation of systemic inequities in communication sciences and disorders (CSD) is the chronic underreporting and underrepresentation of sex, gender, race, and ethnicity in research. The present study characterized recent demographic reporting practices and representation of participants across CSD research.

Methods

We systematically reviewed and extracted key reporting and participant data from empirical studies conducted in the United States (US) with human participants published in the year 2020 in journals by the American Speech-Language-Hearing Association (ASHA; k = 407 articles comprising a total n = 80,058 research participants, search completed November 2021). Sex, gender, race, and ethnicity were operationalized per National Institutes of Health guidelines (National Institutes of Health, 2015a, 2015b).

Results

Sex or gender was reported in 85.5% of included studies; race was reported in 33.7%; and ethnicity was reported in 13.8%. Sex and gender were clearly differentiated in 3.4% of relevant studies. Where reported, median proportions for race and ethnicity were significantly different from the US population, with underrepresentation noted for all non-White racial groups and Hispanic participants. Moreover, 64.7% of studies that reported sex or gender and 67.2% of studies that reported race or ethnicity did not consider these respective variables in analyses or discussion.

Conclusion

At present, research published in ASHA journals frequently fails to report key demographic data summarizing the characteristics of participants. Moreover, apparent gaps in representation of minoritized racial and ethnic groups threaten the external validity of CSD research and broader health care equity endeavors in the US. Although our study is limited to a single year and publisher, our results point to several steps for readers that may bring greater accountability, consistency, and diversity to the discipline.

Patient Characteristics and Treatment Patterns for Speech-Language Pathology Services in Skilled Nursing Facilities

PURPOSE

Skilled nursing facility (SNF) care has historically been influenced by systemic issues that could impact speech-language pathology (SLP) service provision. However, there has been little study specifically on factors associated with SLP service provision in SNFs. Large administrative data sets are rarely analyzed in SLP research but can be used to understand real-world SLP services. This study investigated associations between patient and facility characteristics and SLP services.

METHOD

Mixed-effects logistic regression models were used to evaluate factors associated with SLP service provision in 2018 Medicare administrative data representing 833,653 beneficiaries.

RESULTS

Beneficiaries had higher odds of receiving SLP services when they had neurologic diagnosis (odds ratio [OR] = 3.32), had SLP-related functional impairments (ORs = 1.19-3.41), and received other rehabilitative services (ORs = 3.11-3.78). Beneficiaries had lower odds of receiving SLP services when they received care from SNFs located in hospitals versus freestanding (OR = 0.45), with need for interpreter services (OR = 0.76) and with thresholding (OR = 0.68), a financially motivated practice. Direction of association varied across racial and ethnic groups and measures of location. Odds of being provided SLP services decreased with increasing communication impairment severity.

CONCLUSIONS

The results suggest that clinicians are identifying patients with diagnoses most likely to warrant SLP services. However, association disparities and weakening association of service provision with increasing impairment severity have concerning clinical implications. Health services research methods can be used to further explore SLP practices in SNFs to support equitable service provision.

The urgency of restructuring the landscape of behavioral medicine: Commentary from early-career diversity institute scholars

Structural and systemic barriers entrenched in academia have sustained for decades, and resulted in a lack of diversity in leadership positions, inequitable workloads for women and underrepresented racial/ethnic groups, and increasing issues with retention of faculty, particularly following the COVID-19 pandemic. Increasing opposition to diversity, equity, and inclusion (DEI) efforts in higher education via legislation, policies, and general anti-DEI sentiment contextualizes the importance of prioritizing DEI. The goal of this commentary is to open discussion among academic institutions regarding changes in DEI culture that will facilitate the growth of diverse early-career faculty (ECF). We use an adapted framework which incorporates DEI into a faculty competency model to (i) guide our discussion of the rationale for restructuring academic systems to promote DEI and (ii) recommend strategies for institutional progress for ECF that can translate across academic institutions. Implementing policies and practices that seek to recruit, retain, and support historically underrepresented ECF are needed, and may involve faculty mentorship programs, establishing equitable funding mechanisms, reforming faculty evaluation practices, and examining and correcting inequities in faculty workloads. The onus is on institutions to recognize and replace the exclusionary practices and biases that have existed within their walls, and continuously promote and monitor their DEI efforts and initiatives to ensure their efficacy. Inclusive academic cultures that demonstrate their value of diversity and commitment to equity promotion at all levels of the organization, including among ECF, are necessary for ensuring excellence in scholarship in academia.

The complexities of diagnosis: New Zealand parents' knowledge, perceptions, and experiences of identification of their children's language and literacy difficulties

PURPOSE

This study reported the experiences of New Zealand caregivers of children with language and literacy difficulties in having their child's needs identified.

METHOD

The participants were 14 mothers of children with idiopathic language and literacy difficulties, recruited through social media language and literacy difficulties support groups. Two mothers identified as Māori and 12 New Zealand European. Data were collected through semi-structured interviews. A phenomenological approach using reflexive thematic analysis was used.

RESULT

These mothers had learned about language, literacy, and the education system to advocate for their child and perceived a lack of knowledge on the part of schools. Nearly all had sought a diagnosis, with understanding and access to support reported as positive consequences and stigma as a negative. Some preferred labels emphasising difference rather than disorder, consistent with traditional Māori and neurodiversity views. The mothers described their experience as a fight, due to their concerns being ignored, the need to pay for private diagnostic assessments and difficulty accessing services. They appreciated assessors who gave useful, comprehensible information and supported school liaison.

CONCLUSION

These mothers wanted improved teacher training and publicly funded diagnostic assessment services to improve access to best practice language and literacy instruction for their children.

Multilingual Speech Acquisition by Vietnamese-English-Speaking Children and Adult Family Members

PURPOSE

This article presents a large-scale example of culturally responsive assessment and analysis of multilingual Vietnamese-English-speaking children and their family members using the VietSpeech Protocol involving (a) examining all spoken languages, (b) comparing ambient phonology produced by family members, (c) including dialectal variants in the definition of accuracy, and (d) clustering participants with similar language experience.

METHOD

The VietSpeech participants (N = 154) comprised 69 children (2;0-8;10 [years;months]) and 85 adult family members with Vietnamese heritage living in Australia. Speech was sampled using the Vietnamese Speech Assessment (Vietnamese) and the Diagnostic Evaluation of Articulation and Phonology (English).

RESULTS

Children's Vietnamese consonant accuracy was significantly higher when dialectal variants were accepted (percentage of consonants correct-dialect [PCC-D]: M = 87.76, SD = 8.18), compared to when only Standard Vietnamese was accepted as the correct production (percentage of consonants correct-standard [PCC-S]: M = 70.34, SD = 8.78), Cohen's d = 3.55 (large effect). Vietnamese voiced plosives, nasals, semivowels, vowels, and tones were more often correct than voiceless plosives and fricatives. Children's Standard Australian English consonant accuracy (PCC-S) was 82.51 (SD = 15.57). English plosives, nasals, glides, and vowels were more often correct than fricatives and affricates. Vietnamese word-initial consonants had lower accuracy than word-final consonants, whereas English consonant accuracy was rarely influenced by word position. Consonant accuracy and intelligibility were highest for children with high proficiency in both Vietnamese and English. Children's consonant productions were most similar to their mothers' than other adults or siblings' productions. Adults' Vietnamese consonants, vowels, and tones were more likely to match Vietnamese targets than their children's productions.

CONCLUSIONS

Children's speech acquisition was influenced by cross-linguistic, dialectal, maturational, language experience, and environmental (ambient phonology) factors. Adults' pronunciation was influenced by dialectal and cross-linguistic factors. This study highlights the importance of including all spoken languages, adult family members, dialectal variants, and language proficiency to inform differential diagnosis of speech sound disorders and identify clinical markers in multilingual populations.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23290055.

Implementation of Open Science Practices in Communication Sciences and Disorders Research With Black, Indigenous, and People of Color

PURPOSE

Open science that is truly accessible and transparent to all will enhance reproducibility. However, there are ethical and practical concerns in implementing open science practices, especially when working with populations who are systematically excluded from and marginalized in communication sciences and disorders (CSD) research, such as Black, Indigenous, and People of Color (BIPOC) from clinical populations. The purpose of this article was to discuss these concerns and present actionable steps to support open science in CSD research with BIPOC.

CONCLUSIONS

In the movement toward open and reproducible science, the discipline of CSD must prioritize accessibility and transparency, in addition to the implementation of individual scientific practices. Such a focus requires building trust with BIPOC not only as research participants but also as valued leaders of the scientific community.

Designing accountability measures for health professionals: results from a community-based micro-credential: case study on Indigenous cultural safety

BACKGROUND

There is a widespread commitment to implementing anti-Indigenous racism with health organizations in Canada by introducing cultural safety staff training. In partnership with a public health unit in Ontario, Canada, we developed an evaluation tool to assess the performance of staff who completed an online Indigenous cultural safety education course.

AIMS

To develop an accountability checklist that could be used for annual employee performance reviews to assess the use and level of knowledge received in professional cultural safety training.

INTERVENTION

We co-created a professional development accountability checklist. Five areas of interest were identified: terminology, knowledge, awareness, skills, and behaviours. The checklist comprises of 37 indicators linked to our community collaborators' intended goals as defined in our partnership agreement.

OUTCOMES

The Indigenous Cultural Safety Evaluation Checklist (ICSEC) was shared with public health managers to use during regularly scheduled staff performance evaluations. The public health managers provided feedback on the design, checklist items, and useability of the ICSEC. The pilot of the checklist is in the preliminary stage and data is unavailable about effectiveness.

IMPLICATIONS

Accountability tools are important to sustain the long-term effects of cultural safety education and prioritize the wellbeing of Indigenous communities. Our experience can provide guidance to health professionals in creating and measuring the efficacy of Indigenous cultural safety education to foster an anti-racist work culture as well as improved health outcomes among Indigenous communities.

A Community-Based Approach to Longitudinal Language Research With Racially and Ethnically Minoritized Autistic Young Adults: Lessons Learned and New Directions

PURPOSE

Language and autism research each typically excludes racially and ethnically minoritized (REM) autistic individuals. In addition, in the case of autistic individuals with language impairment, investigators often approach caregivers to discuss research participation, rather than autistic individuals themselves. This gap limits the ecological validity of language research in autism. To address this gap, this clinical focus article describes strategies for engaging REM autistic young adults with language impairment using lessons learned from 5 years of longitudinal research with this population. This approach involved an ongoing community partnership, as well as participatory partnerships with REM autistic individuals and community stakeholders, consistent with a "slow science" approach.

CONCLUSIONS

The approach yielded excellent retention of participants over 5 years and led to co-development of research projects aimed at priorities described by REM autistic individuals and their families, including understanding self-determination, social determinants of health, and language variability in autistic REM individuals with language impairment. Findings support the utility of community-based methods with autistic REM young adults with language impairment, with key takeaways for diversifying research while replicating, extending, and building theory.

Focusing Our Attention on Socially Responsive Professional Education to Serve Ethnogeriatric Populations With Neurogenic Communication Disorders in the United States

PURPOSE

This viewpoint discusses a plausible framework to educate future speech-language pathologists (SLPs) as socially responsive practitioners who serve and advocate for the burgeoning vulnerable ethnogeriatric populations with neurogenic communication disorders.

METHOD

We provide an overview of the demographic, epidemiological, and biopsychosocial context that supports the implementation of equity-based, population-grounded educational approaches for speech-language pathology services in ethnogeriatric neurorehabilitation caseloads and discuss a plausible perspective based on the educational social determinants of health (SDOH) framework by the National Academies of Sciences, Engineering, and Medicine.

RESULTS

The NASEM's three-domain SDOH educational perspective integrates education, community, and organization to create a self-reinforcing pedagogical coproduction that, grounded in the synergized partnerships of educational institutions, engaged communities, and organizational leadership, aims to address systemic drivers of health perpetuating ethnoracial disparities in health, care, and outcomes.

CONCLUSION

Exponentially growing vulnerable ethnogeriatric populations with age-related neurogenic communication disorders warrant the implementation of health equity education strategies to train technically prepared, socially conscious SLPs as service providers and advocates.

Using Active Learning Strategies to Strengthen Cultural and Linguistic Diversity Training in Communication Sciences and Disorders Programs

Purpose

Training in cultural competence is an accreditation requirement for graduate programs in Communication Sciences and Disorders (CSD; Council on Academic Accreditation in Audiology and Speech-Language Pathology, 2020). Cultural and linguistic diversity (CLD) instruction within CSD programs and current instructional models may not provide students with effective training in this area (Hammond et al., 2009; Higby et al., 2021; Stockman et al., 2008). In this paper, we present active learning as an instructional approach that may provide students with stronger training in the assessment and treatment of individuals with unfamiliar cultural and linguistic backgrounds.

Conclusions

Active learning emphasizes the creation of a supportive classroom environment, teaching skills rather than content, and fostering metacognition in students (Bransford et al., 2000; Gooblar, 2019). We propose a three-part pedagogical model for using active learning strategies to improve clinical training in assessment and treatment of clients with CLD backgrounds. This pedagogical model encourages instructors to set the scene for learning, present a problem to solve, and build in reflection and generalization. Active learning approaches, as described in the model, are ideal for teaching clinical problem-solving across populations while reflecting on one's lived experience and positionality. Sample materials for readers to create their own lesson plans using the model are provided and reviewed.

How a Power Differential Between Clinicians and Researchers Contributes to the Research-to-Practice Gap

PURPOSE

The purpose of this article is to contend that there is a power differential between researchers and clinicians where researchers are the primary creators of knowledge and clinicians are the primary consumers of knowledge. Rooted in a sociological model illustrating interacting levels of power at macro-, meso-, and microlevels, we argue that authentic research-practice partnerships and clinician-researcher collaborations can mitigate this power differential.

CONCLUSIONS

Clinicians and researchers in our field have vastly different responsibilities and priorities that impact our ability to work collaboratively to solve the most pressing problems for the clients we serve. Although some current research practices may reinforce a power differential causing clinicians to feel less than and to only consume knowledge, there are examples of successful collaborations where this power differential is mitigated. These examples can contribute meaningfully to the dialogue on research-practice partnerships, with the goal of improving outcomes for the clients we serve.

Still Searching for Understanding: The Importance of Diverse Research Designs, Methods, and Perspectives

BACKGROUND

Evidence-based medicine and evidence hierarchies have been widely adopted and have strongly influenced decision making across many fields, including clinical aphasiology. However, questions remain about the creation, usefulness, and validity of current evidence hierarchies.

AIMS

This article builds on ideas about scientific approaches and evidence originally shared by Elman (1995, 1998, 2006). This article reviews the history of evidence hierarchies and argues that improving the diversity of research designs, methods, and perspectives will improve understanding of the numerous and complex variables associated with aphasia intervention. Researchers and clinicians are encouraged to synthesize diverse types of scientific evidence. It is hoped that this article will stimulate thought and foster discussion in order to encourage high-caliber research of all types.

MAIN CONTRIBUTION

Concepts from a wide variety of fields including philosophy of science, research design and methodology, and precision medicine are brought together in an attempt to focus research on the scientific understanding of aphasia treatment effects.

CONCLUSION

It is hoped that by incorporating diverse research designs, methods, and perspectives, clinical aphasiologists will become better able to provide effective, personalized treatments, ensuring that each person with aphasia is able to improve their communication ability and quality of life.

Incorporating Dis/ability Studies and Critical Race Theory to combat systematic exclusion of Black, Indigenous, and People of Color in clinical neuroscience

This article reviews some of the ideological forces contributing to the systematic exclusion of Black, Indigenous, and People of Color (BIPOC) in clinical neuroscience. Limitations of functional near-infrared spectroscopy (fNIRS) and other methods systematically exclude individuals with coarse or curly hair and darker skin. Despite these well-known limitations, clinical neuroscience manuscripts frequently fail to report participant race or ethnicity or reasons for excluding participants. Grounding the discussion in Dis/ability Studies and Critical Race Theory (DisCrit), we review factors that exacerbate exclusion and contribute to the multiple marginalization of BIPOC, including (a) general methodological issues, (b) perceptions about race and disability, and (c) underreporting of methods. We also present solutions. Just as scientific practices changed in response to the replication crisis, we advocate for greater attention to the crisis of underrepresentation in clinical neuroscience and provide strategies that serve to make the field more inclusive.

Black Children With Developmental Disabilities Receive Less Augmentative and Alternative Communication Intervention Than Their White Peers: Preliminary Evidence of Racial Disparities From a Secondary Data Analysis

PURPOSE

Ensuring equitable access to augmentative and alternative communication (AAC) intervention services for children with complex communication needs (CCN) is crucial. Evidence suggests that racial disparities exist in access to communication interventions, disadvantaging Black children. However, no research has investigated specifically the evidence for racial disparities in AAC services for children with developmental disabilities and CCN.

METHOD

The current study applied post hoc data analysis methods within a preexisting, open-access data set to explore preliminary evidence of racial disparities in AAC intervention. Amount of AAC intervention was compared for Black versus white ¹ preschool students at study initiation (M _age = 3;8 [years;months]) and 2 years later at study completion (M _age = 5;10).

RESULTS

Black preschool students were reported to receive significantly less AAC intervention per week as compared to their white peers, both at study initiation and 2 years later. By study end, 75% of the Black children were receiving less than 60 min of AAC intervention per week, an inadequate amount to achieve meaningful gains given their significant disabilities.

CONCLUSIONS

It is unclear what mechanisms may contribute to the observed disparities; however, it is critical that concrete steps are taken by individual speech-language pathologists, school districts, preservice preparation programs, and researchers to identify inequities in AAC services and take actions to rectify them. Future research is essential to investigate the potential factors contributing to inequalities and determine effective interventions to address them.

Engaging in culturally responsive and globally sustainable practices

Purpose: This article highlights critical issues facing speech, language and hearing educators, clinicians, and scholars that pertain to culturally and linguistically responsive and globally sustainable practices.Method: Points included in this article pertain to the usefulness of understanding causes and consequences of world changes; and the importance of critically examining and reconceptualizing practices in ways that eliminate the vestiges of ableism, racism, and colonialism embedded in those practices.Result: This article provides strategies for moving away from positivist science and a medical model to critical science and a social model of disability for critically analysing the impact that the changing social, political, and global landscapes have on our practices.Conclusion: These strategies will help members of the discipline to rethink policies and standards that can transform practices into those that continue to be culturally responsive, globally sustainable, and relevant in this new global context.

Are People With Poststroke Aphasia Receptive to Transcranial Direct Current Stimulation? A Survey

PURPOSE

The objective of this study was to explore receptiveness of people with poststroke aphasia to receiving transcranial direct current stimulation (tDCS), including preferences for the treatment setting and schedule of tDCS delivery.

METHOD

An online survey was distributed via e-mail, flyers, social media, and online newsletters to reach people with aphasia. Fisher's exact test examined the relationship of self-reported tDCS receptiveness to demographic, clinical, and other factors.

RESULTS

Fifty-seven surveys were returned, and 50 complete surveys were analyzed. Twenty-eight percent of respondents had previously heard of tDCS. Sixty-six percent reported they would receive tDCS if it could help their aphasia, and only 6% reported that they definitely would not. There were statistically significant relationships between being receptive to tDCS and (a) not currently working, (b) being receptive to speech-language therapy, and (c) greater acceptance of potential temporary risks associated with tDCS. Most individuals (73%) who would consider tDCS were equivalently open to receiving it in the clinic or at home, yet the majority (64%) were open to more frequent sessions at home than in the clinic. Most respondents indicated that they would consider having tDCS "forever if it helped" (clinic: 51%; home: 68%).

CONCLUSIONS

This is the first study to query individuals with aphasia about their receptiveness to tDCS outside the context of an intervention study. Responses suggest that a large majority of people with poststroke aphasia might be open to receiving tDCS if it can ameliorate their aphasia. Limitations include the small sample size, which does not adequately represent the broader population of people with aphasia, and that the survey did not provide the level of tDCS education crucial to inform shared decision making and person-centered care. However, future work may benefit from considering the practical implications of research designs (e.g., high intensity treatment outside the home) that may not, in application, be widely acceptable to primary stakeholders.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19611777.

Community-Based Participatory Research and Human-Centered Design Principles to Advance Hearing Health Equity

OBJECTIVES

Inclusive and equitable research is an ethical imperative. Community-based participatory research (CBPR) as well as human-centered design are approaches that center partnership between community members and academic researchers. Together, academic-community research teams iteratively study community priorities, collaboratively develop ethical study designs, and co-create innovations that are accessible and meaningful to the community partners while advancing science. The foundation of the CBPR approach is reliant on its core principles of equity, colearning, shared power in decision-making, reciprocity, and mutual benefit. While the CBPR approach has been used extensively in public health and other areas of healthcare research, the approach is relatively new to audiology, otolaryngology, and hearing health research. The purpose of the present article is to advance an understanding of the CBPR approach, along with principles from human-centered design, in the context of research aimed to advance equity and access in hearing healthcare.

DESIGN

The literature is reviewed to provide an introduction for auditory scientists to the CBPR approach and human-centered design, including discussion of the underlying principles of CBPR and where it fits along a community-engaged continuum, theoretical and evaluation frameworks, as well as applications within auditory research.

RESULTS

Recent applications of CBPR have been framed broadly within the theoretical positions of the socioecological model for a systems-level approach to community-engaged research and the Health Services Utilization model within health services and disparities research using CBPR. Utilizing human-centered design strategies can work in tandem with a CBPR approach to engage a wide range of people in the research process and move toward the development of innovative yet feasible solutions.

CONCLUSIONS

Leveraging the principles of CBPR is an intricate and dynamic process, may not be a fit for some topics, some researchers' skillsets, and may be beyond some projects' resources. When implemented skillfully and authentically, CBPR can be of benefit by elevating and empowering community voices and cultural perspectives historically marginalized in society and underrepresented within research. With a focus on health equity, this review of CBPR in the study of hearing healthcare emphasizes how this approach to research can help to advance inclusion, diversity, and access to innovation.

Receipt of treatment among a nationally representative sample of US adults with communication disorders

INTRODUCTION

A robust body of literature exists on clinical research outcomes for persons with communication disorders (CD). Comparatively few studies have examined population-based health service outcomes for CD-related services, which capture persons with CDs who may not be part of clinical or administrative data. This is important to describe access to treatment and the factors impacting access. We address this gap, describing four CD-related healthcare outcomes among adults reporting problems with communication (voice, speech, and language): (1) utilization, (2) utilization determinants, (3) professionals providing CD care, and (4) patient-reported service-related outcomes.

METHODS

We conducted a retrospective, cross-sectional study of community-dwelling adults (≥18 years) in the US self-reporting CD on the nationally representative 2012 National Health Interview Survey. Separate analyses examined adults with voice (n = 1,323), speech (n = 658), and language (n = 396) disorders. We used survey weighted logistic regression to assess the likelihood of treatment, controlling for health, disorder, and sociodemographic characteristics; Pearson's chi square was calculated for other outcomes.

RESULTS

An estimated 10% of adults reporting CD described receiving care addressing their CD. Employment, sociodemographic and economic status, health insurance, level of severity, and presence of co-occurring CD were associated with receiving treatment. Over half of respondents with speech and language disorders and less than a fifth of respondents with voice disorders reported receiving care from speech-language pathologists. Adults who received CD-related services reported improvements in activities (52-69% overall) and CD (33-48% overall).

CONCLUSIONS

This population-based study shows that general access to CD services is low. Underserved populations have less access to treatment than their counterparts with more resources. Improving access to CD services requires creative interventions addressing patient and provider needs, as well as healthcare system design. Population-based follow-up studies are necessary to track progress toward improving access to care.

Introduction to the Forum: Increasing Diversity in the Communication Sciences and Disorders Workforce, Part 1

Purpose This introduction provides background information about this forum of the American Journal of Speech-Language Pathology and a preview of articles published in this first installment of the forum.