"People suffer and we see this": a qualitative study of the forms of patient psychological distress encountered by physiotherapists

BACKGROUND

Psychological distress is a common response to many conditions physiotherapists treat. It is also common for a person's experience of distress to be associated with multiple stressors.

OBJECTIVE

This qualitative study explored physiotherapists' perceptions of the types of patient psychological distress they encountered in their clinical practice.

METHODS

A qualitative research approach was adopted. Twenty-three physiotherapists were recruited through purposive maximum variation sampling. To participate, physiotherapists had to self-report having encountered at least one patient they perceived to be experiencing psychological distress in the last 12 months. Data analysis was completed using Iterative Thematic Inquiry.

RESULTS

Five themes were identified in the study: 1) distress extends beyond physical health issues; 2) fear of the future; 3) the emotional toll of loss; 4) trauma is often part of the story; and 5) losing hope.

CONCLUSION

The results of this study highlight that patient psychological distress presents in a variety of forms and appears to be multifaceted and multifactorial in nature. As patients' experiences of psychological distress are relevant to physiotherapy practice, mental health capabilities need to be embedded within physiotherapy training.

Stakeholder perspectives following implementation of Vietnam's first speech-language pathology degrees: recommendations for future curriculum development

PURPOSE

To investigate perspectives of multiple stakeholders involved in development and delivery of Vietnam's first speech-language pathology degrees and derive recommendations for future degrees in Vietnam and other Majority World countries.

METHODS

An exploratory-descriptive qualitative research design using focus groups and individual semi-structured interviews in the preferred language (English or Vietnamese) was used, with 70 participants from five stakeholder groups: project managers, students, academic educators, placement supervisors and interpreters. Transcriptions were analysed using thematic network analysis.

RESULTS

Analysis identified five organising themes: (1) People enjoyed working with/learning from others; (2) Benefits from/to stakeholders; (3) The pandemic impacted program delivery and learning; (4) Practical challenges; (5) Preparation with flexibility required for success and sustainability. From the five organising themes, one synthesising global theme was developed, conveying that satisfying international collaborations require preparation, support, high quality interpreting, and management of challenges.

CONCLUSIONS

Recommendations highlight the need for preparation, collaboration, support to manage challenges, flexibility, recognition for placement supervisors and high-quality interpreting. The recommendations are of relevance to other organisations engaged in development of professional degrees in Majority World countries. Future research would benefit from a critical investigation of the diverse perspectives of stakeholders involved in the development and implementation of international curricula.

Physiotherapists often encounter clients disclosing suicidal thoughts and behaviors: a cross-sectional survey of Australian physiotherapists

BACKGROUND

All health professionals have a role in suicide prevention, although little is known about physiotherapists' contact with clients experiencing suicidal thoughts and behaviors.

OBJECTIVE

The aims of this study were to investigate physiotherapists' self-reported frequency of contact with clients who disclose suicidal thoughts and behaviors and to identify potential factors associated with frequency of contact.

METHODS

Three-hundred and thirty-eight Australian physiotherapists were surveyed using an online questionnaire, with an estimated response rate of 6.1%. Data were analyzed using descriptive analysis and logistic regression.

RESULTS

Over half the respondents (52.1%) reported encountering clients at least once a year who disclosed suicidal thoughts, and nearly half (49.4%) reported having received at least one disclosure of a suicide plan at some point in their career. Among those working in the public sector, 67.5% of respondents reported having received a disclosure of a suicide plan, and almost all physiotherapists working in pain management reported having received such a disclosure (93.8%). The binary logistic regression model explained approximately 39.7% of the variance in whether a physiotherapist had a client disclose a plan for suicide at some point in their career or not.

CONCLUSION

The results highlight that all physiotherapists should receive training in suicide prevention.

Supporting children's recovery from bushfires: Stakeholders' views about the impact of a community-based intervention program on children

INTRODUCTION

A multidisciplinary Bushfire Recovery Program was developed by Royal Far West focused on reducing the short- and medium-term impacts of the 2019-2020 bushfires in Australia on children's wellbeing and resilience.

OBJECTIVES

To evaluate the impact of the Program's psychosocial groups on children's wellbeing and resilience.

DESIGN

A two-phase mixed method approach was used, involving post-intervention surveys and interviews of children impacted by the 2019-2020 bushfires in Australia who participated in the Bushfire Recovery Program, their parents/carers, teachers, and the facilitators of the workshops. Statistical analysis was undertaken with quantitative data and content and thematic analysis of qualitative data.

FINDINGS

Children learnt to talk to and trust adults, share thoughts and experiences with others, recognise they were not alone in their experiences, build connections with peers, understand and manage feelings, and implement strategies that enabled them to cope with change.

DISCUSSION

Psychosocial groups delivered in preschools and schools as part of the Bushfire Recovery Program reportedly led to significant learning and positive impacts for children in the areas of coping, wellbeing, and peer connections. Similar themes occurred across surveys and interviews and findings reflected the perceptions of the children who participated in the groups, and key adults around the children.

CONCLUSIONS

Community-based psychoeducational interventions can provide effective support in the short- and medium-term post-bushfire for children to develop strategies and skills to enable them to cope with changes and their emotional reactions.

"We take on people's emotions": a qualitative study of physiotherapists' experiences with patients experiencing psychological distress

BACKGROUND

Previous research suggests that physiotherapists frequently engage with patients who experience psychological distress (e.g. feelings of depression and anxiety) and that physiotherapists find supporting these patients challenging.

OBJECTIVE

The aim of this study was to explore the experiences of Australian physiotherapists with patients they perceived were experiencing psychological distress.

METHODS

A 'Big Q' qualitative research approach was used. Twenty-three interviews with physiotherapists were conducted. The data were then analyzed using iterative thematic inquiry.

RESULTS

The analysis produced four interrelated themes: 1) encounters with patients in distress are common and varied; 2) becoming emotionally attuned with their patients meant that distress could invoke empathetic distress; 3) physiotherapists use emotional shields to protect themselves; and 4) physiotherapists found frequent encounters with patient distress to be emotionally exhausting. Viewed together, the themes highlight how patient distress can invoke transient empathetic distress in a physiotherapist; repeated experiences of empathetic distress may lead to empathetic distress fatigue.

CONCLUSION

While physiotherapists are sometimes viewed as 'physical' health professionals, the experiences of these physiotherapists suggest that patient psychological distress is highly relevant to physiotherapy practice. We recommend future research explores the relationships between patient distress, physiotherapists' empathy, and physiotherapists' wellbeing.

Eligibility Determinations for Speech and Language Services in U.S. Public Schools: Experiences and Tensions

PURPOSE

The purpose of this study was to examine school speech-language pathologists' (SLPs) experiences regarding students' eligibility for services in public schools within the United States.

METHOD

Fifteen school SLPs participated in online focus groups to examine the complex nature of SLPs' participation within decision-making teams and describe practice experiences in U.S. schools. SLPs worked in one to 10+ schools serving students from pre-K through 12th grade. Data were analyzed using Cultural-Historical Activity Theory (CHAT; Engeström, 2015).

RESULTS

School SLPs' practice is impacted by rules, community, and division of labor in schools. Participants discussed the following: culture of the work setting, interaction between team members, desire to assist families and children, knowledge of regulations, evaluation practices, and the impact of poverty, and cultural and linguistic differences. Nine major tensions were identified: need for greater SLP empowerment and advocacy, documentation of educational impact, complexities of students learning English as an additional language, concerns about evaluation data for decision making, SLPs' concerns regarding outcomes of eligibility decision making, overuse of speech-language impairment for students who do not qualify, parents' involvement in decision making, disagreement between team members, and administrations' adherence to rules.

CONCLUSIONS

Within the schools, the CHAT framework was useful to identify tensions and opportunities for change at the individual and institutional levels, impacting team decision making for eligibility, SLPs' provision of services, and student outcomes. Acknowledgment of tensions and opportunities for change regarding students' eligibility for services may guide public policy; preservice training; and individual, local, and national advocacy.

Recommended approaches to assessing and managing physiotherapy clients experiencing psychological distress: a systematic mapping review

BACKGROUND

Some physiotherapists find assessing and managing clients experiencing psychological distress challenging and are uncertain regarding the boundaries of the profession's scope.

OBJECTIVE

To map the approaches recommended for physiotherapists in scholarly literature, with respect to the assessment and management of clients experiencing psychological distress.

METHODS

A systematic mapping review was conducted. CINAHL, APA PsycINFO, Embase, and Medline ALL databases were systematically searched for secondary and tertiary literature relevant to the research objective. Recommended approaches were extracted from each article and analyzed descriptively and thematically.

RESULTS

3884 records were identified with 40 articles meeting the inclusion/exclusion criteria. Most recommendations related to identifying, assessing, and managing pain-related distress, with depression screening and referral also receiving some attention. Three approaches to detecting and assessing psychological distress were identified: 1) brief depression screen; 2) integrated suicide/nonsuicidal self-harm and depression screen; and 3) multidimensional screen and health-related distress assessment. Regarding the management of psychological distress the main approaches identified were: 1) education and reassurance; 2) cognitive-behavioral approaches; 3) mindfulness; and 4) case management.

CONCLUSION

While assessment and management of health-related distress by physiotherapists is commonly recommended, further guidance is needed to differentiate various forms of distress.

Preventing Suicide: Time to Mobilize the Physical Therapist Workforce

Each year, approximately 700,000 people, including 46,000 Americans, die by suicide; however, many more people experience suicidal thoughts and behaviors. Historically, the prevention of suicide has largely been the domain of mental health professionals working within specialist mental health care settings. An issue with this approach is that many individuals who experience suicidal ideation never disclose these thoughts to a mental health professional. The nonprofessional and paraprofessional mental health movement aims to bring suicide prevention to the people who need it, rather than wait for them to seek help. The nonprofessional and paraprofessional mental health movement does so by upskilling people who are not recognized as mental health professionals but may have contact with people experiencing suicidal thoughts and behaviors. In this Perspective, we argue that physical therapists are well-positioned to engage in suicide prevention. For example, physical therapists working in pain management are likely to frequently encounter clients experiencing suicidal thoughts and behaviors. Physical therapy is also viewed as a physical health profession, meaning that they may have contact with a broad range of populations at high risk of suicide who may be difficult to reach through traditional channels (eg, men from rural communities). Physical therapists will require training on how to provide crisis support, including how to link clients with appropriate mental health services. However, given the size of the physical therapist workforce globally, the impact of mobilizing the physical therapist workforce could be significant.

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.

Transcribing multilingual children's and adults' speech

Speech-language pathologists (SLPs) face challenges in transcription and diagnosis of speech sound disorders (SSD) in multilingual children due to ambient language influences and cross-linguistic transfer. The VietSpeech Multilingual Transcription Protocol, a 4-step process to undertake impressionistic transcription of multilingual speech was tested using data from Vietnamese-Australian children (n = 69) and adult family members (n = 85). The transcription team included an English-speaking SLP, a Vietnamese-English-speaking linguist and accredited interpreter, and two Vietnamese-English-speaking SLPs. (1) Training: The team completed training together in Vietnamese and English phonology. (2) Speech assessment: The participants were assessed using the Diagnostic Evaluation of Articulation and Phonology (DEAP) in English and the Vietnamese Speech Assessment (VSA). (3) Transcription comparison: Inter-rater reliability for 10 children and 12 adults was calculated using consonant-by-consonant agreement. For English the 3-way inter-rater agreement was 92.62% for children and 88.69% for adults. For Vietnamese the 4-way inter-rater agreement was 86.57% for children and 96.05% for adults. There was a significant correlation between speech accuracy and inter-rater reliability for children's consonants in English (r = 0.95) and Vietnamese (r = 0.91), and adults' consonants in English (r = 0.90), but not for Vietnamese (r = 0.49). Reliability was influenced by phoneme class and whether the target consonant was shared between languages. (4) Rule generation and consensus: Rules based on near functional equivalence were implemented to maintain consistency and reach consensus. SLPs who do not speak clients' home languages can be supported to transcribe multilingual speech by working with multilingual teams, and understanding personal limitations during multilingual speech assessments.

Australian physiotherapists' perceived frequency of contact with clients experiencing distress: A cross-sectional survey

BACKGROUND

Previous research suggests physiotherapists' perceived frequency of contact with clients experiencing psychological distress is common; however, there is significant variation in the frequency of such contact.

OBJECTIVE

The study aimed to 1) investigate Australian physiotherapists' perceived frequency of contact with clients experiencing various forms of psychological distress; 2) identify potential factors that predict perceived frequency of contact; and 3) explore physiotherapists' beliefs regarding their role and self-reported capability to identify and assess psychological distress.

METHODS

A nationwide online survey of 340 Australian physiotherapists was conducted, and the data were analyzed using descriptive analysis and regression analysis.

RESULTS

Physiotherapists' perceived frequencies of contact with psychologically distressed and severely distressed clients expressed as proportions of all clients seen each week were 36.1% and 15.6%, respectively. Factors related to the clinical setting were stronger predictors of the perceived frequency of contact (Cohen's f2 = 0.16) than factors related to the physiotherapists themselves (Cohen's f2 = 0.03). Despite believing that identifying psychological distress was within their scope of practice, the physiotherapists in the study felt that assessing and managing this distress fell outside or on the boundary of their scope of practice.

CONCLUSION

Australian physiotherapists frequently encounter clients they perceive to be experiencing psychological distress. Future research into physiotherapists' capability to assess and respond to client psychological distress, using non-self-reported measures, is required.

The impact of climate-related disasters on children's communication and wellbeing: Addressing Sustainable Development Goals

PURPOSE

Natural disasters can significantly impact children's health, development, and wellbeing, as well as their access to education and support services (including speech-language pathology). Children's needs are often overlooked in the urgent aftermath of natural disasters. This is especially true for children with communication difficulties. This commentary explores the impacts of bushfire on Australian children, to propose a sustainable, community-based approach to supporting children's health, wellbeing, and communication.

RESULT

The Royal Far West Bushfire Recovery Program, a multidisciplinary allied health program, supported children's recovery, resilience, and development in the aftermath of Australia's Black Summer bushfires in 2019-2020. Children learnt coping strategies and were more able to communicate with adults and peers about their feelings and experiences, but residual impacts of bushfires remained for some children. Allied health telepractice services, including speech-language pathology, enhanced access for vulnerable children, highlighting the potential for technology to provide high-quality services to support recovery, particularly in remote areas.

CONCLUSION

Climate change increases the frequency and severity of bushfires and other natural disasters with significant consequences for vulnerable and at-risk communities. Children with communication needs are particularly vulnerable during and following these disasters. High quality, evidence-based interventions are needed to support the health, wellbeing, and communication needs of children, with opportunities for involvement of speech-language pathologists. This commentary paper focusses on SDG 1, SDG 3, SDG 4, SDG 9, SDG 10, SDG 11, SDG 13, and SDG 15.

Building diversity in the speech-language pathology workforce through a blended online Master of Speech Pathology

Purpose: A lack of diversity in the speech-language pathology profession is widely recognised internationally. The role of speech-language pathology education in reproduction of this homogeneity and as a barrier to diversification is little understood. The potential of blended online education to increase access to education and diversify the speech-language pathology profession is yet to be explored. The purpose of the study was to investigate the profile of students engaging in the first blended online speech-language pathology course in Australia, including motivations for studying, experiences of studying via a blended online mode, and intentions for future practice.Method: Data were collected from 44 students in the first Australian blended online Master of Speech Pathology via an online survey. Quantitative data were analysed using descriptive statistics in SPSS and a content analysis of the qualitative data was conducted using NVivo.Result: With over 92% of participants choosing the course because it was offered online, flexible blended online study provided opportunity for those who would not have otherwise accessed speech-language pathology education, including rural students and those balancing work and home commitments. Participants found face to face elements of the course essential to their learning, but also the most challenging to manage and to fit around other commitments. Participants' ideal work scenarios revealed that 82.9% wished to practice within 50kms of their current location, indicating that provision of tertiary education to people in rural areas is contributing to establishing and retaining a rurally focussed speech-language pathology workforce.Conclusion: Blended online study provides an opportunity to diversify the speech-language profession by providing access to students such as rural students and those balancing work and home commitments with tertiary education. By reducing barriers to studying speech-language pathology, flexible learning is helping address issues of access and equity in service delivery across Australia.

Speech acquisition within a 3-generation Vietnamese-English family: the influence of maturation and ambient phonology

The emergence approach to speech acquisition theorises the influence of intrinsic capabilities (e.g., maturation), interactional capabilities, and extrinsic contexts (e.g., ambient phonology). Intrinsic and extrinsic influences were examined via a case study of a 3-generation Vietnamese-English family with two brothers (C1 aged 5;6 and C2 aged 3;10), their mother (M), grandfather (GF) and grandmother (GM). Their speech was assessed using the Diagnostic Evaluation of Articulation and Phonology (DEAP) and the Vietnamese Speech Assessment (VSA). Standard Australian English/Standard Vietnamese productions were defined as 'correct', even though the adults spoke different Vietnamese dialects. Their percentage of standard consonants correct (PSCC) was: C1 (English:92.27%, Vietnamese:89.05%), C2 (E:86.47%, VN:86.13%), M (E:90.34%, VN:96.35%), GF (E:82.61%, VN:97.81%), GM (VN:99.27%). Percentages were higher when dialectal variants were included. C1 and C2 had more pronunciation matches with English (86.96%) than Vietnamese (79.56%). C1's pronunciation matched: M (E:85.02%, VN:83.94%), GF (E:79.23%, VN:77.37%), GM (VN:73.72%) and C2's pronunciation matched: M (E:79.23%, VN:73.72%), GF (E:73.91%, VN:75.18%), GM (VN:72.26%). There was evidence of ambient phonology influences and cross-linguistic transfer. For example, in Vietnamese 'r' is produced as /ʐ/ or /r/ , but was produced by C1 as [ɹ] (English approximant) and by C2 [w] (age-appropriate/ɹ/substitution). The children demonstrated maturation influences for late-occurring English consonants (e.g., English /θ/ →[f]). This study found evidence for the emergence approach and recommends knowledge of the ambient phonology augments traditional child-focused understandings of children's speech acquisition.

SuperSpeech: Multilingual Speech and Language Maintenance Intervention for Vietnamese-Australian Children and Families via Telepractice

PURPOSE

The aim of this pilot feasibility study was to evaluate the effectiveness of the group VietSpeech SuperSpeech program targeting speech skills and home language maintenance via telepractice.

METHOD

In Stage 1, using a case-control design, 30 Vietnamese-English-speaking children were assessed in English and Vietnamese, and parents completed questionnaires about speech and language competency and practices. During Stage 2, children were allocated to intervention (n = 14) or control (n = 16) conditions. COVID-19 restrictions resulted in changes including nonrandom allocation. Online group intervention targeting speech, home language maintenance, and multilingualism as a superpower was delivered 1 hr/week for 8 weeks. For Stage 3, assessments were undertaken approximately 10 weeks after the pre-intervention assessment.

RESULTS

Parents in the intervention group significantly increased encouragement of their children to speak Vietnamese. The intervention group significantly increased intelligibility in English. Growth of Vietnamese vocabulary was faster for the control group. There was a moderate effect of intervention for children's perception of being happy talking in Vietnamese and English. There was no significant mean change from pre- to post-intervention compared with the control group for measures of speech sound accuracy in Vietnamese or English, Vietnamese intelligibility, English vocabulary, or hours of Vietnamese spoken each week.

CONCLUSIONS

This study presents preliminary evidence that this 8-hr online group program targeting speech skills and home language maintenance had some impact on Vietnamese-Australian children's speech and home language maintenance. Further research involving a randomized trial is warranted.

Family Language Policies of Vietnamese–Australian Families

This study aimed to investigate reported family language policies (quy tắc sử dụng ngôn ngữ cho gia đình) and language maintenance practices among Vietnamese–Australian parents. This mixed-methods study collected 151 Vietnamese–Australian parents' responses to close- and open-ended questions within an online questionnaire that was available both in English and Vietnamese. Bivariate analyses and logistic regression were conducted to explore associations between family language policies and factors related to demographics and Spolsky's language policy theory. Content analysis was undertaken in NVivo to investigate family language policies. One-third of the participants (35.6%) reported to have a family language policy and 72.5% of those with a policy indicated that they consistently implemented their policy. Significant factors associated with having a family language policy were parents' higher Vietnamese proficiency, more Vietnamese language use with their children, and intention of future residence in Vietnam. The four identified language policies were as follows: (1) using Vietnamese with the nuclear family (FLP1), (2) Vietnamese outside the nuclear family (FLP2), (3) English at home (FLP3), and (4) English outside the home (FLP4). Some families used more than one of these concurrently. This is one of the first large-scale mixed-method studies to explore family language policies, and the first to explore this issue with Vietnamese-speaking families in Australia. Many Vietnamese–Australian families do not explicitly have a family language policy aimed at maintaining Vietnamese at home; therefore, the Vietnamese–Australian community is at risk of a shift toward English language dominance and home language loss. As a result, the benefits of multilingualism within the Vietnamese–Australian community may be lost without support from the government and community to maintain their home language.

The Influence of Linguistic Bias Upon Speech-Language Pathologists' Attitudes Toward Clinical Scenarios Involving Nonstandard Dialects of English

Purpose Variation within languages, including dialects, takes on an indexical function, marking belonging and connection. Meanwhile, attitudes toward these speech varieties become marked by linguistic bias. Within the speech-language pathology profession, research evidence, assessment tools, and intervention programs have largely been designed for and by the White, English-speaking middle class. As such, linguistic bias with a preference for standardized dialects is prevalent in the training and practice of the speech-language pathology profession, resulting in discriminatory and racialized practices. Method To investigate the influence of linguistic bias upon speech-language pathologists' (SLPs') clinical decision making, data were collected from 129 Australian SLPs via an online survey. Inferential statistics were used to investigate the relationship between clinical decision making and SLPs' attitudes toward nonstandard dialects as well as personal and professional factors. A content analysis of extended responses was conducted to identify themes in clinical decision making. Results SLPs with more years of experience and those who had received professional development were significantly more likely to seek out more information before making a diagnosis, while those with more negative attitudes toward linguistic diversity were significantly more likely to identify a disorder than a difference. SLPs provided a range of justifications for their clinical decision making, but few acknowledged the influence of their own attitudes and bias upon their decision making. Conclusions SLPs' linguistic bias towards speakers of nonstandard dialects has the potential to impact upon their clinical judgment of difference versus disorder and lead to inequality of service provision for speakers who do not express themselves in standardized forms. Before the profession can truly move toward an antiracist approach of equitable service provision for all, SLPs must engage in critical self-reflection to disrupt the adherence of the speech-language pathology profession to standardized "White" norms of communication.

Advancing Workplace Diversity Through the Culturally Responsive Teamwork Framework

Purpose Diversification of the profession is an important element of combating racism, bias, and prejudice in the speech-language pathology workforce at national and systemic levels. However, national and systemic change needs to be combined with equipping individual speech-language pathologists to adapt to the challenges that they face to engaging in culturally responsive practice. This paper presents four interacting levels of practice within the Culturally Responsive Teamwork Framework (CRTF): (a) intrapersonal practices, (b) interpersonal practices, (c) intraprofessional practices, and (d) the interprofessional practices. Conclusion CRTF is a practical, strengths-based framework that draws on international research and expertise to expand personal and professional practice and describe critical behaviors within the workplace that can be used to promote principles of evidence-based practice and social justice, especially when working with people from nondominant cultural or linguistic groups.

Profiles of Linguistic Multicompetence in Vietnamese-English Speakers

Purpose Speech-language pathologists work with increasing numbers of multilingual speakers; however, even when the same languages are spoken, multilingual speakers are not homogeneous. Linguistic multicompetence (aka multi-competence) considers competency across all languages and is associated with multiple demographic, migration, linguistic, and cultural factors. Method This article examines the linguistic multicompetence of adults with Vietnamese heritage living in Australia (n = 271) and factors associated with varying profiles of multilingualism. Participants completed a self-report questionnaire (available in English and Vietnamese) regarding their language proficiency and associated factors. Results Participants were largely (76.6%) first-generation migrants to Australia. Three distinct profiles of linguistic multicompetence were statistically identified using a cluster analysis: (a) Vietnamese proficient (n = 81, 31%), (b) similar proficiency (n = 135, 52%), and (c) English proficient (n = 43, 17%); that is, half were proficient in both languages. Multinomial logistic regression analyses compared participants profiled as having similar proficiency with those who were more dominant in one language. Factors associated with the Vietnamese proficient group (compared with the similar proficiency group) were that the participants used Vietnamese much more than English with different people across different situations, were more likely to believe that maintaining Vietnamese helped them communicate in English, and earned less. Participants in the English proficient group used English more than Vietnamese with different people across different situations, were more likely to have lived in English-speaking countries longer, were younger in age, and were less likely to believe that maintaining Vietnamese helped improve academic study than those with similar proficiency. Conclusion Undertaking a comprehensive language profile is an important component of any multilingual assessment to enable speech-language pathologists to develop an understanding of different presentations of linguistic multicompetence, engage in culturally responsive practice, and acknowledge that high levels of competence can be achieved across multiple languages. Supplemental Material https://doi.org/10.23641/asha.14781984.

The impact of linguistic bias upon speech-language pathologists' attitudes towards non-standard dialects of English

Dialectal variations are present in all languages, originating from cultural, geographic and socioeconomic diversity. This study investigates speech-language pathologists' (SLPs) linguistic bias towards non-standard language forms and dialects, and factors that may impact on these attitudes. Language attitude studies reveal that negative attitudes towards variation can lead to bias against speakers of non-standard dialects. If SLPs hold linguistic bias towards speakers of non-standard dialects, this has the potential to impact upon their clinical judgement of difference vs. disorder and lead to inequality of service provision. A total of 129 Australian SLPs completed an online survey, which involved ranking 28 attitudinal statements regarding language variation on a 5-point scale from strongly disagree to strongly agree. The survey data were analysed using a factor analysis in SPSS to identify latent factors that identified attitudes towards non-standard dialects followed by inferential analyses to investigate how attitudes were related to the demographic data of participants. Results identified five key factors from the survey, these were (1) Use of non-standard English, (2) Language impurity, (3) Diversity in form, (4) Social acceptability, and (5) Prescriptive language rules. SLPs held generally positive attitudes towards the use of non-standard forms and the socially determined acceptability of language. SLPs were more neutral in their attitudes towards diversity in form and the need for prescriptive rules and generally held negative views towards language purity (e.g., the use of "youse" as a plural form of you). A significantly positive association was found between professional development (PD) on cultural and linguistic diversity and positive attitudes towards Factors 1 and 3. Years of practice were significantly related to Factor 2, with less experienced SLPs holding more negative views relating to language purity. While many SLPs identify the value of language variation and its reflection of a person's cultural and linguistic diversity, negative attitudes towards non-standard forms and variation in school and occupational settings have the potential to negatively impact differential diagnosis, goal setting and the delivery of culturally responsive speech-language pathology services to speakers of non-standard dialects.

Persistence, strength, isolation, and trauma: An ethnographic exploration of raising children with cleft palate

BACKGROUND

The lives of families of young children with cleft palate (±lip) are complex. Multiple interventions are required as part of the long-term multidisciplinary treatment for children with CP±L, with an impairment-focused approach prevailing. Research with young children with CP±L has focused on treatment and intervention, and previous qualitative research has been collected predominantly via interviews, so little is understood about the day-to-day lives of families of young children with CP±L.

AIMS

(1) To increase understanding of the lives of children with CP±L and their families by applying an ethnographic lens to improve clinical practice (2) to identify key interactions and encounters that shape the experiences of children with CP±L and their families (3) to examine how family-centered practice can enhance practitioner-family relationships in providing effective and evidence-based care for children with CP±L.

METHOD

Ethnographic observations of seven families of children with CP±L and their families and educators including parents, siblings, aunts, grandparents, and teachers involved multiple site visits. Rich data were collected to gather information about different aspects of their lives (such as their strengths, routines, preferences, challenges and experiences). There were 84 artefacts collected: 18 interviews, 29 videos, one extended audio recording of a mealtime, seven photos contributed by families, seven case history questionnaires, and 22 field notes. These data were analyzed inductively using thematic analysis.

RESULTS

Three overarching themes and 11 subthemes were identified: (1) the whole child (persistence, communication, activities, mealtimes), (2) family strength and support (strong families, external support, attitudes, advocacy, positive medical experiences) and (3) family isolation and trauma (negative medical experiences, traumatic and challenging experiences).

CONCLUSION

This is the first study to use ethnographic methodology to facilitate the collection of unique insights into the lives of young children with CP±L and their families to improve clinical practice for SLPs. The unique application of family-centered practice with these families promoted trust and highlighted their challenges and strengths which could be considered by SLPs to provide holistic intervention.

Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia

CHAPTER 1: RETAIL INITIATIVES TO IMPROVE THE HEALTHINESS OF FOOD ENVIRONMENTS IN RURAL, REGIONAL AND REMOTE COMMUNITIES: Objective: To synthesise the evidence for effectiveness of initiatives aimed at improving food retail environments and consumer dietary behaviour in rural, regional and remote populations in Australia and comparable countries, and to discuss the implications for future food environment initiatives for rural, regional and remote areas of Australia.

STUDY DESIGN

Rapid review of articles published between January 2000 and May 2020.

DATA SOURCES

We searched MEDLINE (EBSCOhost), Health and Society Database (Informit) and Rural and Remote Health Database (Informit), and included studies undertaken in rural food environment settings in Australia and other countries.

DATA SYNTHESIS

Twenty-one articles met the inclusion criteria, including five conducted in Australia. Four of the Australian studies were conducted in very remote populations and in grocery stores, and one was conducted in regional Australia. All of the overseas studies were conducted in rural North America. All of them revealed a positive influence on food environment or consumer behaviour, and all were conducted in disadvantaged, rural communities. Positive outcomes were consistently revealed by studies of initiatives that focused on promotion and awareness of healthy foods and included co-design to generate community ownership and branding.

CONCLUSION

Initiatives aimed at improving rural food retail environments were effective and, when implemented in different rural settings, may encourage improvements in population diets. The paucity of studies over the past 20 years in Australia shows a need for more research into effective food retail environment initiatives, modelled on examples from overseas, with studies needed across all levels of remoteness in Australia. Several retail initiatives that were undertaken in rural North America could be replicated in rural Australia and could underpin future research. CHAPTER 2: WHICH INTERVENTIONS BEST SUPPORT THE HEALTH AND WELLBEING NEEDS OF RURAL POPULATIONS EXPERIENCING NATURAL DISASTERS?: Objective: To explore and evaluate health and social care interventions delivered to rural and remote communities experiencing natural disasters in Australia and other high income countries.

STUDY DESIGN

We used systematic rapid review methods. First we identified a test set of citations and generated a frequency table of Medical Subject Headings (MeSH) to index articles. Then we used combinations of MeSH terms and keywords to search the MEDLINE (Ovid) database, and screened the titles and abstracts of the retrieved references.

DATA SOURCES

We identified 1438 articles via database searches, and a further 62 articles via hand searching of key journals and reference lists. We also found four relevant grey literature resources. After removing duplicates and undertaking two stages of screening, we included 28 studies in a synthesis of qualitative evidence.

DATA SYNTHESIS

Four of us read and assessed the full text articles. We then conducted a thematic analysis using the three phases of the natural disaster response cycle.

CONCLUSION

There is a lack of robust evaluation of programs and interventions supporting the health and wellbeing of people in rural communities affected by natural disasters. To address the cumulative and long term impacts, evidence suggests that continuous support of people's health and wellbeing is needed. By using a lens of rural adversity, the complexity of the lived experience of natural disasters by rural residents can be better understood and can inform development of new models of community-based and integrated care services. CHAPTER 3: THE IMPACT OF BUSHFIRE ON THE WELLBEING OF CHILDREN LIVING IN RURAL AND REMOTE AUSTRALIA: Objective: To investigate the impact of bushfire events on the wellbeing of children living in rural and remote Australia.

STUDY DESIGN

Literature review completed using rapid realist review methods, and taking into consideration the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for systematic reviews.

DATA SOURCES

We sourced data from six databases: EBSCOhost (Education), EBSCOhost (Health), EBSCOhost (Psychology), Informit, MEDLINE and PsycINFO. We developed search terms to identify articles that could address the research question based on the inclusion criteria of peer reviewed full text journal articles published in English between 1983 and 2020. We initially identified 60 studies and, following closer review, extracted data from eight studies that met the inclusion criteria.

DATA SYNTHESIS

Children exposed to bushfires may be at increased risk of poorer wellbeing outcomes. Findings suggest that the impact of bushfire exposure may not be apparent in the short term but may become more pronounced later in life. Children particularly at risk are those from more vulnerable backgrounds who may have compounding factors that limit their ability to overcome bushfire trauma.

CONCLUSION

We identified the short, medium and long term impacts of bushfire exposure on the wellbeing of children in Australia. We did not identify any evidence-based interventions for supporting outcomes for this population. Given the likely increase in bushfire events in Australia, research into effective interventions should be a priority. CHAPTER 4: THE ROLE OF NATIONAL POLICIES TO ADDRESS RURAL ALLIED HEALTH, NURSING AND DENTISTRY WORKFORCE MALDISTRIBUTION: Objective: Maldistribution of the health workforce between rural, remote and metropolitan communities contributes to longstanding health inequalities. Many developed countries have implemented policies to encourage health care professionals to work in rural and remote communities. This scoping review is an international synthesis of those policies, examining their effectiveness at recruiting and retaining nursing, dental and allied health professionals in rural communities.

STUDY DESIGN

Using scoping review methods, we included primary research - published between 1 September 2009 and 30 June 2020 - that reported an evaluation of existing policy initiatives to address workforce maldistribution in high income countries with a land mass greater than 100 000 km² .

DATA SOURCES

We searched MEDLINE, Ovid Embase, Ovid Emcare, Informit, Scopus, and Web of Science. We screened 5169 articles for inclusion by title and abstract, of which we included 297 for full text screening. We then extracted data on 51 studies that had been conducted in Australia, the United States, Canada, United Kingdom and Norway.

DATA SYNTHESIS

We grouped the studies based on World Health Organization recommendations on recruitment and retention of health care workers: education strategies (n = 27), regulatory change (n = 11), financial incentives (n = 6), personal and professional support (n = 4), and approaches with multiple components (n = 3).

CONCLUSION

Considerable work has occurred to address workforce maldistribution at a local level, underpinned by good practice guidelines, but rarely at scale or with explicit links to coherent overarching policy. To achieve policy aspirations, multiple synergistic evidence-based initiatives are needed, and implementation must be accompanied by well designed longitudinal evaluations that assess the effectiveness of policy objectives. CHAPTER 5: AVAILABILITY AND CHARACTERISTICS OF PUBLICLY AVAILABLE HEALTH WORKFORCE DATA SOURCES IN AUSTRALIA: Objective: Many data sources are used in Australia to inform health workforce planning, but their characteristics in terms of relevance, accessibility and accuracy are uncertain. We aimed to identify and appraise publicly available data sources used to describe the Australian health workforce.

STUDY DESIGN

We conducted a scoping review in which we searched bibliographic databases, websites and grey literature. Two reviewers independently undertook title and abstract screening and full text screening using Covidence software. We then assessed the relevance, accessibility and accuracy of data sources using a customised appraisal tool.

DATA SOURCES

We searched for potential workforce data sources in nine databases (MEDLINE, Embase, Ovid Emcare, Scopus, Web of Science, Informit, the JBI Evidence-based Practice Database, PsycINFO and the Cochrane Library) and the grey literature, and examined several pre-defined websites.

DATA SYNTHESIS

During the screening process we identified 6955 abstracts and examined 48 websites, from which we identified 12 publicly available data sources - eight primary and four secondary data sources. The primary data sources were generally of modest quality, with low scores in terms of reference period, accessibility and missing data. No single primary data source scored well across all domains of the appraisal tool.

CONCLUSION

We identified several limitations of data sources used to describe the Australian health workforce. Establishment of a high quality, longitudinal, linked database that can inform all aspects of health workforce development is urgently needed, particularly for rural health workforce and services planning. CHAPTER 6: RAPID REALIST REVIEW OF OPIOID TAPERING IN THE CONTEXT OF LONG TERM OPIOID USE FOR NON-CANCER PAIN IN RURAL AREAS: Objective: To describe interventions, barriers and enablers associated with opioid tapering for patients with chronic non-cancer pain in rural primary care settings.

STUDY DESIGN

Rapid realist review registered on the international register of systematic reviews (PROSPERO) and conducted in accordance with RAMESES standards.

DATA SOURCES

English language, peer-reviewed articles reporting qualitative, quantitative and mixed method studies, published between January 2016 and July 2020, and accessed via MEDLINE, Embase, CINAHL Complete, PsycINFO, Informit or the Cochrane Library during June and July 2020. Grey literature relating to prescribing, deprescribing or tapering of opioids in chronic non-cancer pain, published between January 2016 and July 2020, was identified by searching national and international government, health service and peek organisation websites using Google Scholar.

DATA SYNTHESIS

Our analysis of reported approaches to tapering conducted across rural and non-rural contexts showed that tapering opioids is complex and challenging, and identified several barriers and enablers. Successful outcomes in rural areas appear likely through therapeutic relationships, coordination and support, by using modalities and models of care that are appropriate in rural settings and by paying attention to harm minimisation.

CONCLUSION

Rural primary care providers do not have access to resources available in metropolitan centres for dealing with patients who have chronic non-cancer pain and are taking opioid medications. They often operate alone or in small group practices, without peer support and access to multidisciplinary and specialist teams. Opioid tapering approaches described in the literature include regulation, multimodal and multidisciplinary approaches, primary care provider support, guidelines, and patient-centred strategies. There is little research to inform tapering in rural contexts. Our review provides a synthesis of the current evidence in the form of a conceptual model. This preliminary model could inform the development of a model of care for use in implementation research, which could test a variety of mechanisms for supporting decision making, reducing primary care providers' concerns about potential harms arising from opioid tapering, and improving patient outcomes.

Trust, conversations and the 'middle space': A qualitative exploration of the experiences of physiotherapists with clients with suicidal thoughts and behaviours

In Australia, physiotherapists are registered healthcare practitioners who possess the knowledge and skills to care for clients with poor physical health as a result of musculoskeletal, neurological, and respiratory conditions. Although physiotherapists are not considered a primary profession in the Australian mental health workforce, the association between suicide and poor physical health suggests that they may encounter clients with suicidal thoughts and behaviours. We used a qualitative approach inspired by phenomenology to explore the experiences of nine physiotherapists who encountered clients with suicidal thoughts and behaviours. We used a combination of focus groups and in-depth interviews to collect this data. The data were analysed inductively using framework analysis. The main themes identified in the data were: i) the importance of trust, ii) the mechanism of conversation, and iii) the 'middle space'. The middle space refers to the experience of working with clients at risk of low or medium risk of suicide. A trusting practitioner-client relationship was reported to be essential in facilitating the disclosure of suicidal thoughts and behaviours. Physiotherapists also reported that less structured subjective assessments encourage clients to talk more openly, which in turn facilitates the disclosure of suicidal thoughts and behaviours. Once the disclosure of suicidal thoughts and behaviours occurred, physiotherapists reported a lack of confidence regarding role clarity and issues associated with this. Difficulties were most evident during encounters with clients with low to medium suicide risk due to a lack of confidence in the accuracy of assessment of these clients. The findings suggest that physiotherapists are well placed to detect and/or receive disclosure of suicidal thoughts and behaviours, as well as the need for physiotherapists to be trained in how to support clients who disclose suicidal thoughts and behaviours.

Holistic Communication Assessment for Young Children With Cleft Palate Using the International Classification of Functioning, Disability and Health:Children and Youth

Purpose Children with a cleft palate (± cleft lip; CP±L) can have difficulties communicating and participating in daily life, yet speech-language pathologists typically focus on speech production during routine assessments. The International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY; World Health Organization, 2007) provides a framework for holistic assessment. This tutorial describes holistic assessment of children with CP±L illustrated by data collected from a nonclinical sample of seven 2- to 3-year-old children, 13 parents, and 12 significant others (e.g., educators and grandparents). Method Data were collected during visits to participants' homes and early childhood education and care centers. Assessment tools applicable to domains of the ICF-CY were used to collect and analyze data. Child participants' Body Functions including speech, language, and cognitive development were assessed using screening and standardized assessments. Participants' Body Structures were assessed via oral motor examination, case history questionnaires, and observation. Participants' Activities and Participation as well as Environmental and Personal Factors were examined through case history questionnaires, interviews with significant others, parent report measures, and observations. Results Valuable insights can be gained from undertaking holistic speech-language pathology assessments with children with CP±L. Using multiple tools allowed for triangulation of data and privileging different viewpoints, to better understand the children and their contexts. Several children demonstrated speech error patterns outside of what are considered cleft speech characteristics, which underscores the importance of a broader assessment. Conclusion Speech-language pathologists can consider incorporating evaluation of all components and contextual factors of the ICF-CY when assessing and working with young children with CP±L to inform intervention and management practices.

Applying the ICF-CY to Specialist Speech-Language Pathologists’ Practice With Toddlers With Cleft Palate Speech

Objective:

To evaluate how the practice of specialist speech-language pathologists (SLPs) working with young children with cleft palate ± cleft lip (CP±L) maps onto the International Classification of Functioning, Disability, and Health – Children and Youth version (ICF-CY) and consider the functionality of the categories of the ICF-CY for this specialist area of practice.

Design:

Cross-sectional, qualitative study.

Setting:

Semistructured face-to-face interviews were conducted with SLPs working in tertiary-level hospitals, universities, and public clinics.

Participants:

Six specialist SLPs with 17 to 39 years of experience working with young children with CP±L as researchers and clinicians in Australia, Brazil, Denmark, Ireland, New Zealand, and the United States.

Main Outcome Measure(s):

Specialists’ practices were captured using in-depth, semistructured interviews. Data collected were analyzed by directed content analysis applying the ICF-CY as a coding schema.

Results:

In total, 4077 data points were coded. Most mapped onto Body Structures (684, 16.8%), Body Functions (906, 22.2%), and Environmental Factors (1626, 39.9%) with less emphasis on Activities and Participation (560, 13.7%). A “best fit” approach was taken to topics that did not map exactly onto categories of the ICF-CY (eg, velopharyngeal insufficiency [VPI]); however, there was not always an ideally suitable category available.

Conclusions:

The current study revealed strengths and challenges in categorizing practice within the ICF-CY for children with CP±L, including collaboration with parents and significant others, specificity around speech, language, and articulation, and the different types of VPI. Therefore, future discussion around how best to use the framework with children with CP±L is needed.

Language Proficiency, Use, and Maintenance among People with Vietnamese Heritage Living in Australia

Multilingualism provides cultural, economic and social benefits to individuals and societies. Many people with Vietnamese heritage have migrated to English-speaking countries such as Australia, Canada and the US. This study describes language proficiency, use and maintenance of 271 adults with Vietnamese heritage living across Australia. The majority were first-generation immigrants (76.6%), spoke Vietnamese as their first language (94.3%), and indicated Vietnamese was their most proficient language (78.5%). The majority were more likely to use Vietnamese (than English) with their mother, father, older siblings, Vietnamese-speaking grandparents, relatives in Vietnam, and Vietnamese friends. They used English and Vietnamese with their partners, children, younger siblings and English-speaking grandparents. They were more likely to speak English when working, studying and watching TV, but used English and Vietnamese equally on social media. The most important reasons for maintaining Vietnamese were: maintaining bonds with relatives, maintaining Vietnamese cultural identity, and building friendships.

Intelligibility Enhancement Assessment and Intervention: a single-case experimental design with two multilingual university students

Speech-language pathologists (SLPs) may be approached by multilingual speakers wishing to improve their intelligibility in English. Intelligibility is an essential element of spoken language proficiency and is particularly important for multilingual international students given their need to express complex ideas in an additional language. Intelligibility Enhancement aims to improve the intelligibility and acceptability of consonants, vowels and prosody with multilingual speakers who are learning to speak English. This study aimed to describe the Intelligibility Enhancement Assessment and Intervention Protocols and determine whether the intervention changed multilingual university students' English intelligibility. A multiple-baseline single-case experimental design was applied with direct inter-subject replication across two female participants whose home languages were Vietnamese and Putonghua (Mandarin). English intelligibility was assessed at multiple intervals pre, post and during intervention. The intervention protocol consisted of 11 weekly 1-h sessions with an SLP targeting English consonants, vowels and prosody. Following intervention, both participants displayed increased performance across most measures. For example, the Vietnamese participant's percentage of consonants correct (PCC) increased from 62.5% to 85.0% in probe keywords. Effect sizes, when comparing baseline and withdrawal phases, were 5.5 for PCC, 4.6 for final consonants, 2.3 for consonant clusters and 1.6 for syllables indicating improvements in all variables measured. Her speech rate reduced, word stress increased in accuracy and she perceived less difficulty communicating in English. These promising results suggest further testing of the Intelligibility Enhancement Protocols is warranted to determine effectiveness as an intervention for multilingual speakers.

The relationship between spoken English proficiency and participation in higher education, employment and income from two Australian censuses

PURPOSE

Proficiency in the language of the country of residence has implications for an individual's level of education, employability, income and social integration. This paper explores the relationship between the spoken English proficiency of residents of Australia on census day and their educational level, employment and income to provide insight into multilingual speakers' ability to participate in Australia as an English-dominant society.

METHOD

Data presented are derived from two Australian censuses i.e. 2006 and 2011 of over 19 million people.

RESULT

The proportion of Australians who reported speaking a language other than English at home was 21.5% in the 2006 census and 23.2% in the 2011 census. Multilingual speakers who also spoke English very well were more likely to have post-graduate qualifications, full-time employment and high income than monolingual English-speaking Australians. However, multilingual speakers who reported speaking English not well were much less likely to have post-graduate qualifications or full-time employment than monolingual English-speaking Australians.

CONCLUSION

These findings provide insight into the socioeconomic and educational profiles of multilingual speakers, which will inform the understanding of people such as speech-language pathologists who provide them with support. The results indicate spoken English proficiency may impact participation in Australian society. These findings challenge the "monolingual mindset" by demonstrating that outcomes for multilingual speakers in education, employment and income are higher than for monolingual speakers.

Tutorial: Speech Assessment for Multilingual Children Who Do Not Speak the Same Language(s) as the Speech-Language Pathologist

PURPOSE

The aim of this tutorial is to support speech-language pathologists (SLPs) undertaking assessments of multilingual children with suspected speech sound disorders, particularly children who speak languages that are not shared with their SLP.

METHOD

The tutorial was written by the International Expert Panel on Multilingual Children's Speech, which comprises 46 researchers (SLPs, linguists, phoneticians, and speech scientists) who have worked in 43 countries and used 27 languages in professional practice. Seventeen panel members met for a 1-day workshop to identify key points for inclusion in the tutorial, 26 panel members contributed to writing this tutorial, and 34 members contributed to revising this tutorial online (some members contributed to more than 1 task).

RESULTS

This tutorial draws on international research evidence and professional expertise to provide a comprehensive overview of working with multilingual children with suspected speech sound disorders. This overview addresses referral, case history, assessment, analysis, diagnosis, and goal setting and the SLP's cultural competence and preparation for working with interpreters and multicultural support workers and dealing with organizational and government barriers to and facilitators of culturally competent practice.

CONCLUSION

The issues raised in this tutorial are applied in a hypothetical case study of an English-speaking SLP's assessment of a multilingual Cantonese- and English-speaking 4-year-old boy. Resources are listed throughout the tutorial.

Supporting culturally and linguistically diverse children with speech, language and communication needs: Overarching principles, individual approaches

Speech-language pathologists (SLPs) are working with an increasing number of families from culturally and linguistically diverse backgrounds as the world's population continues to become more internationally mobile. The heterogeneity of these diverse populations makes it impossible to identify and document a one size fits all strategy for working with culturally and linguistically diverse families. This paper explores approaches to practice by SLPs identified as specialising in multilingual and multicultural practice in culturally and linguistically diverse contexts from around the world. Data were obtained from ethnographic observation of 14 sites in 5 countries on 4 continents. The sites included hospital settings, university clinics, school-based settings, private practices and Indigenous community-based services. There were 652 individual artefacts collected from the sites which included interview transcripts, photographs, videos, narrative reflections, informal and formal field notes. The data were analysed using Cultural-Historical Activity Theory (Engeström, 1987). From the analysis six overarching Principles of Culturally Competent Practice (PCCP) were identified. These were: (1) identification of culturally appropriate and mutually motivating therapy goals, (2) knowledge of languages and culture, (3) use of culturally appropriate resources, (4) consideration of the cultural, social and political context, (5) consultation with families and communities, and (6) collaboration between professionals. These overarching principles align with the six position statements developed by the International Expert Panel on Multilingual Children's Speech (2012) which aim to enhance the cultural competence of speech pathologists and their practice. The international examples provided in the current study demonstrate the individualised ways that these overarching principles are enacted in a range of different organisational, social, cultural and political contexts. Tensions experienced in enacting the principles are also discussed. This paper emphasises the potential for individual SLPs to enhance their practice by adopting these overarching principles to support the individual children and families in diverse contexts around the world.

Reconceptualizing practice with multilingual children with speech sound disorders: people, practicalities and policy

BACKGROUND

The speech and language therapy profession is required to provide services to increasingly multilingual caseloads. Much international research has focused on the challenges of speech and language therapists' (SLTs) practice with multilingual children.

AIMS

To draw on the experience and knowledge of experts in the field to: (1) identify aspirations for practice, (2) propose recommendations for working effectively with multilingual children with speech sound disorders, and (3) reconceptualize understandings of and approaches to practice.

METHODS & PROCEDURES

Fourteen members of the International Expert Panel on Multilingual Children's Speech met in Cork, Ireland, to discuss SLTs' practice with multilingual children with speech sound disorders. Panel members had worked in 18 countries and spoke nine languages. Transcripts of the 6-h discussion were analysed using Cultural-Historical Activity Theory (CHAT) as a heuristic framework to make visible the reality and complexities of SLTs' practice with multilingual children.

OUTCOMES & RESULTS

Aspirations and recommendations for reconceptualizing approaches to practice with multilingual children with speech sound disorders included: (1) increased training for working with multilingual children, their families, and interpreters, (2) increased training for transcribing speech in many languages, (3) increased time and resources for SLTs working with multilingual children and (4) use of the International Classification of Functioning, Disability and Health (ICF-CY).

CONCLUSIONS & IMPLICATIONS

The reality and complexities of practice identified in this paper highlight that it is not possible to formulate and implement one 'gold standard' method of assessment and intervention for all multilingual children with speech sound disorders. It is possible, however, to underpin practice with a framework that ensures comprehensive assessment, accurate diagnosis and effective intervention. This paper proposes that by working towards the aspirations of the Expert Panel, SLTs can be empowered to facilitate appropriate services for multilingual children regardless of the context in which they live and the languages they speak.

A review of 30 speech assessments in 19 languages other than English

PURPOSE

In this study, the authors aimed to evaluate instruments designed to assess children's speech production in languages other than English.

METHOD

Ninety-eight speech assessments in languages other than English were identified: 62 were commercially published, 17 published within journal articles, and 19 informal assessments. A review was undertaken of 30 commercially published assessments that could be obtained.

RESULTS

The 30 instruments assessed 19 languages: Cantonese, Danish, Finnish, German, Greek, Japanese, Korean, Maltese-English, Norwegian, Pakistani-heritage languages (Mirpuri, Punjabi, Urdu), Portuguese, Putonghua (Mandarin), Romanian, Slovenian, Spanish, Swedish, and Turkish. The majority (70.0%) assessed speech sound production in monolingual speakers, 20.0% assessed one language of bilingual speakers, and 10.0% assessed both languages of bilingual speakers. All used single-word picture elicitation. Approximately half (53.3%) were norm-referenced, and the number of children in the normative samples ranged between 145 and 2,568. The remaining assessments were criterion-referenced (50.0%) (one fitted both categories). The assessments with English manuals met many of the psychometric criteria for operationalization; however, only 2 provided sensitivity and specificity data.

CONCLUSIONS

Despite the varying countries of origin, there were many similarities between speech assessments in languages other than English. Few were designed for use with multilingual children, so validation is required for use in English-speaking contexts.

A geographical analysis of speech-language pathology services to support multilingual children

The speech-language pathology workforce strives to provide equitable, quality services to multilingual people. However, the extent to which this is being achieved is unknown. Participants in this study were 2849 members of Speech Pathology Australia and 4386 children in the Birth cohort of the Longitudinal Study of Australian Children (LSAC). Statistical and geospatial analyses were undertaken to identify the linguistic diversity and geographical distribution of Australian speech-language pathology services and Australian children. One fifth of services offered by Speech Pathology Australia members (20.2%) were available in a language other than English. Services were most commonly offered in Australian Sign Language (Auslan) (4.3%), French (3.1%), Italian (2.2%), Greek (1.6%), and Cantonese (1.5%). Among 4-5-year-old children in the nationally representative LSAC, 15.3% regularly spoke and/or understood a language other than English. The most common languages spoken by the children were Arabic (1.5%), Italian (1.2%), Greek (0.9%), Spanish (0.9%), and Vietnamese (0.9%). There was a mismatch between the location of and languages in which multilingual services were offered, and the location of and languages spoken by children. These findings highlight the need for SLPs to be culturally competent in providing equitable services to all clients, regardless of the languages they speak.

International aspirations for speech-language pathologists' practice with multilingual children with speech sound disorders: development of a position paper

A major challenge for the speech-language pathology profession in many cultures is to address the mismatch between the "linguistic homogeneity of the speech-language pathology profession and the linguistic diversity of its clientele" (Caesar & Kohler, 2007, p. 198). This paper outlines the development of the Multilingual Children with Speech Sound Disorders: Position Paper created to guide speech-language pathologists' (SLPs') facilitation of multilingual children's speech. An international expert panel was assembled comprising 57 researchers (SLPs, linguists, phoneticians, and speech scientists) with knowledge about multilingual children's speech, or children with speech sound disorders. Combined, they had worked in 33 countries and used 26 languages in professional practice. Fourteen panel members met for a one-day workshop to identify key points for inclusion in the position paper. Subsequently, 42 additional panel members participated online to contribute to drafts of the position paper. A thematic analysis was undertaken of the major areas of discussion using two data sources: (a) face-to-face workshop transcript (133 pages) and (b) online discussion artifacts (104 pages). Finally, a moderator with international expertise in working with children with speech sound disorders facilitated the incorporation of the panel's recommendations. The following themes were identified: definitions, scope, framework, evidence, challenges, practices, and consideration of a multilingual audience. The resulting position paper contains guidelines for providing services to multilingual children with speech sound disorders (http://www.csu.edu.au/research/multilingual-speech/position-paper). The paper is structured using the International Classification of Functioning, Disability and Health: Children and Youth Version (World Health Organization, 2007) and incorporates recommendations for (a) children and families, (b) SLPs' assessment and intervention, (c) SLPs' professional practice, and (d) SLPs' collaboration with other professionals.

LEARNING OUTCOMES

Readers will 1. recognize that multilingual children with speech sound disorders have both similar and different needs to monolingual children when working with speech-language pathologists. 2. Describe the challenges for speech-language pathologists who work with multilingual children. 3. Recall the importance of cultural competence for speech-language pathologists. 4. Identify methods for international collaboration and consultation. 5. Recognize the importance of engaging with families and people within their local communities for supporting multilingual children in context.

An investigation of equity of rural speech-language pathology services for children: a geographic perspective

The World Health Organization's equity objective states that there should be equal access to healthcare for equal need, regardless of location. Disparities between health services and challenges to achieving the equity objective have been documented both in Australia and around the world. However, little is known about the extent to which this objective has been met in the field of speech-language pathology in Australia. This study used structured interviews with 74 speech-language pathologists working in rural areas of New South Wales and Victoria. The data obtained were used to develop maps to describe the availability of paediatric speech-language pathology services through consideration of location and frequency. The findings show that 98.60% of localities are unserviced at the ideal frequency of weekly or more often. It is important to note that these percentages include all localities in the represented rural areas of New South Wales and Victoria, some of which are minimally populated. The maps also depict travel and distance as barriers to the accessibility of services and have been used to suggest a critical maximum distance for paediatric outpatient speech-language pathology services in rural New South Wales and Victoria. From the data collected, 50 kilometres was suggested as the critical maximum distance past which consumers become unable or unwilling to travel to access weekly rural speech-language pathology services in rural New South Wales and Victoria. Thus, people living in almost one third of rural localities in rural New South Wales and Victoria lie beyond what is considered by rural speech-language pathologists to be a reasonable travel distance to weekly speech-language pathology services. These results highlight barriers to the achievement of equitable services in rural areas. The results also provide an essential foundation to inform policy development and assist health service planning to meet the needs of rural consumers.