Supporting people with aphasia to ‘settle into a new way to be’: speech and language therapists’ views on providing psychosocial support

Background: People with aphasia are at risk of becoming depressed and isolated. On-line surveys have found that the majority of Speech and Language Therapists (SLTs) lack confidence in addressing the psychological needs of people with aphasia. Aims: To explore how SLTs conceptualise the scope of their role; barriers and facilitators to SLTs addressing psychosocial needs; and SLTs’ experiences of specialist training and support, and working with mental health professionals (MHPs). Methods and procedures: Focus groups conducted in stroke healthcare settings. Purposive sampling was used in selecting sites so as to capture a range of experiences. Results were analysed using Framework Analysis. Outcomes and Results: Twenty-three SLTs took part in six focus groups. Participants’ psychosocial work included counselling-type interactions, psychoeducation, working with families, facilitating peer support, and training other healthcare professionals. There was a lack of consensus on the scope of the SLT role. Many expressed a sense of conflict, both perceiving it as valuable to spend time addressing psychological well-being, while simultaneously feeling uneasy if they deviated from ‘direct SLT’ work. Barriers to addressing psychosocial wellbeing were: emotionally challenging nature of this work, particularly for those who felt unsupported; caseload and time pressures; attitude of senior managers and commissioners; difficulties measuring and documenting more ‘fluid’ psychosocial work; and the complexity of needs and backgrounds of some patients. Enabling factors were: specialist on-going support; peer support from colleagues; experience; support of management; and personal belief. Specialist training was valued. It changed how participants viewed the therapist-client relationship (more client-led); the assessment and goal setting process; and gave them more confidence to acknowledge client emotions. However, many felt that there was a need for on-going specialist advice, and to be able to see approaches modelled for this client group. In terms of mental health professionals (MHPs), a subset of stroke specialist clinical psychologists worked directly with people with marked aphasia and families, as well as supporting the multidisciplinary team to provide holistic care. However, a main theme was that participants perceived many MHPs did not consider people with aphasia as ‘appropriate candidates’ for psychological input. Conclusions and Implications: All participants cared about the emotional well-being of their clients; however, they identified a number of barriers to people with aphasia receiving appropriate psychological support. A cultural shift, whereby psychological care for people with aphasia is seen as valuable, feasible and necessary, delivered collaboratively by SLTs, MHPs and the wider team, may improve services

Author Impact Metrics in Communication Sciences and Disorder Research

Purpose: The purpose was to examine author-level impact metrics for faculty in the communication sciences and disorder research field across a variety of databases. Method: Author-level impact metrics were collected for faculty from 257 accredited universities in the United States and Canada. Three databases (i.e., Google Scholar, ResearchGate, and Scopus) were utilized. Results: Faculty expertise was in audiology (24.4%; n = 490) and speech-language pathology (75.6%; n = 1,520). Women comprised 68.1% of faculty, and men comprised 31.9% of faculty. The percentage of faculty in the field of communication sciences and disorders identified in each database was 10.5% (n = 212), 44.0% (n = 885), and 84.4% (n = 1,696) for Google Scholar, ResearchGate, and Scopus, respectively. In general, author-level impact metrics were positively skewed. Metric values increased significantly with increasing academic rank (p < .05), were greater for men versus women (p < .05), and were greater for those in audiology versus speech-language pathology (p < .05). There were statistically significant positive correlations between all author-level metrics (p < .01). Conclusions: These author-level metrics may serve as a benchmark for scholarly production of those in the field of communication sciences and disorders and may assist with professional identity management, tenure and promotion review, grant applications, and employment

The working practices and clinical experiences of paediatric speech and language therapists: a national UK survey

Background: The majority of speech and language therapists (SLTs) work with children who have speech, language and communication needs. There is limited information about their working practices and clinical experience and their views of how changes to healthcare may impact upon their practice. Aims: To investigate the working practices and professional experiences of paediatric SLTs working in the UK through an online survey. Methods & Procedures: The survey was conducted online using Survey Monkey. Therapists were alerted to the survey through the Bulletin of the Royal College of Speech and Language Therapists and by e-mails to national special interest groups. Outcomes & Results: A total of 516 clinicians completed the survey. A large majority worked in the National Health Service (NHS). A varied pattern of working was revealed. Most worked in several settings and saw a range of clients. A typical clinician spends less than one-quarter of their time giving direct therapy and more than one-quarter training parents and other professionals. Nearly half of respondents felt that their time could be better used. Too little time for direct therapy and the time required for administration emerged as their principal concerns. Most clinicians have specialist knowledge of particular client groups and spend more time with them than do non-specialists. Nevertheless, clients are more likely to be treated by a therapist who does not claim to have specialist knowledge of their condition than by one who does. The only clients for whom this is not the case are those with dysphagia. Eighty per cent of respondents felt that proposed changes to the NHS would not benefit the children they treat and there was widespread concern about cuts and the effects of general practitioner commissioning. Despite this, a large majority expected to remain speech and language therapists 5 years from now. Conclusions & Implications : This survey provides an overview of the working practices of paediatric speech and language therapists. Its findings have significant implications for training and workforce development in the profession

Speech and language therapy/pathology: Perspectives on a gendered profession

Background: The Speech and Language Therapy/Pathology (SLT/SLP) profession is characterised by extreme ‘occupational sex segregation’, a term used to refer to persistently male or female-dominated professions. Men make up only 2.5% of all SLTs in the UK, and similar imbalance is found in other countries. Despite calls to increase diversity in the allied health professions more generally, research into the reasons for occupational sex segregation and gender as a potential key factor remains scarce. Aims: This study aims to explore the potential role of gender/ gendered discourses in people’s decision to pursue a career in SLT/SLP. It seeks to illustrate how gendered assumptions/ expectations/ discourses continue to construct SLT as a ‘gendered’ profession, and to make some recommendations in this area for SLT recruitment and practice. Methods & Procedure: The study adopted a qualitative design which elicited research participants’ views, knowledge and experiences (in their own words) in relation to the research questions. Data collection involved two iterative phases: preliminary data phase – which involved semi-structured interviews with newly qualified SLT graduates and practising SLTs, and completion of questionnaires by undergraduate SLTs – and main/ focus group phase. In the focus group phase, reported in this paper, six focus groups in total were held with SLTs, teachers of speech and language therapy, and careers advisors in London, UK. The data were analysed qualitatively using grounded theory principles, thematic analysis, and discourse analysis. Outcomes & Results: The findings extend our knowledge and understanding of gender as a parameter of people’s motivations and perceptions, which can influence their choice of career (e.g. as regards, pay and flexibility). The findings also show that discourses around women as carers, nurturers, and communicators constitute key ways through which the SLT profession continues to be constructed as ‘women’s work’. The topic of structural gender inequalities in the profession was also discussed in the data. Some recommendations for change, with implications for SLT recruitment and practice, were made by the participants themselves. Conclusions & Implications: Gender imbalance in SLT needs to be researched further, in order to help address inequalities, re-evaluate professional practices, and develop service delivery in the profession. This area also needs to be researched via analysis that goes beyond gender distribution in numerical terms, to consider the complex perceptions or discourses around gender and work. Cross-disciplinary and comparative perspectives in future research would also be fruitful

A systematic scoping review of speech and language therapists’ public health practice for early language development

Background: There have been calls for speech and language therapists (SLTs) to work within a public-health framework to support language development. Innovative practice is reported, but the range of services remains unknown. Furthermore, the potential impact of public health practice in speech and language therapy on early child development is also currently unknown. A new method in SLT research, systematic scoping reviews enable greater breadth of focus than traditional systematic reviews when identifying innovative practice. Aim: To report scope and critically appraise evidence of family-focused health-promotion practice for early language development in this area. Methods & Procedures: Using the Cochrane Public Health Group scoping review framework, data from reports of health-promotion practice with families of children aged 0-3 years were extracted and critically appraised on service delivery, information, reach and evaluation. Main contribution: Group-based service delivery was the most popular form of service delivery. There were limited reports on the information given in services and on their reach. Questionnaires were the most popular reported evaluation method. Quality of evaluations was poor due to lack of replicability and experimental control in the studies reported. Conclusions & Implications: This method of systematic review has highlighted the scope of health-promotion practice in speech and language therapy and also demonstrated the lack of evidence for its effectiveness on child language development. It is argued that systematic scoping reviews are valuable for scoping innovative practice in areas where either there is a lack of robust evidence or there is a high level of heterogeneity in practice or evaluation. To support clinician appraisal of available evidence, recommendations are given for development of questionnaire appraisal and for categorization of evidence levels on summary databases

How much exposure to English is necessary for a bilingual toddler to perform like a monolingual peer in language tests?

Background Bilingual children are under-referred due to an ostensible expectation that they lag behind their monolingual peers in their English acquisition. The recommendations of the Royal College of Speech and Language Therapists (RCSLT) state that bilingual children should be assessed in both the languages known by the children. However, despite these recommendations, a majority of speech and language professionals report that they assess bilingual children only in English as bilingual children come from a wide array of language backgrounds and standardized language measures are not available for the majority of these. Moreover, even when such measures do exist, they are not tailored for bilingual children. Aims It was asked whether a cut-off exists in the proportion of exposure to English at which one should expect a bilingual toddler to perform as well as a monolingual on a test standardized for monolingual English-speaking children. Methods & Procedures Thirty-five bilingual 2;6-year-olds exposed to British English plus an additional language and 36 British monolingual toddlers were assessed on the auditory component of the Preschool Language Scale, British Picture Vocabulary Scale and an object-naming measure. All parents completed the Oxford Communicative Development Inventory (Oxford CDI) and an exposure questionnaire that assessed the proportion of English in the language input. Where the CDI existed in the bilingual's additional language, these data were also collected. Outcomes & Results Hierarchical regression analyses found the proportion of exposure to English to be the main predictor of the performance of bilingual toddlers. Bilingual toddlers who received 60% exposure to English or more performed like their monolingual peers on all measures. K-means cluster analyses and Levene variance tests confirmed the estimated English exposure cut-off at 60% for all language measures. Finally, for one additional language for which we had multiple participants, additional language CDI production scores were significantly inversely related to the amount of exposure to English. Conclusions & Implications Typically developing 2;6-year-olds who are bilingual in English and an additional language and who hear English 60% of the time or more, perform equivalently to their typically developing monolingual peers

Service delivery and intervention intensity for phonology-based speech sound disorders

Background: When planning evidence-based intervention services for children with phonology-based speech sound disorders (SSD), speech and language therapists (SLTs) need to integrate research evidence regarding service delivery and intervention intensity within their clinical practice. However, relatively little is known about the optimal intensity of phonological interventions and whether SLTs’ services align with the research evidence.Aims: The aims are twofold. First, to review external evidence (i.e., empirical research evidence external to day-today clinical practice) regarding service delivery and intervention intensity for phonological interventions. Second,to investigate SLTs’ clinical practice with children with phonology-based SSD in Australia, focusing on service delivery and intensity. By considering these complementary sources of evidence, SLTs and researchers will be better placed to understand the state of the external evidence regarding the delivery of phonological interventions and appreciate the challenges facing SLTs in providing evidence-based services.Methods & Procedures: Two studies are presented. The first is a review of phonological intervention research published between 1979 and 2016. Details regarding service delivery and intervention intensity were extractedfrom the 199 papers that met inclusion criteria identified through a systematic search. The second study was an online survey of 288 SLTs working in Australia, focused on the service delivery and intensity of intervention provided in clinical practice.Main Contributions: There is a gap between the external evidence regarding service delivery and intervention intensity and the internal evidence from clinical practice. Most published intervention research has reported toprovide intervention two to three times per week in individual sessions delivered by an SLT in a university clinic, in sessions lasting 30–60 min comprising 100 production trials. SLTs reported providing services at intensities below that found in the literature. Further, they reported workplace, client and clinician factors that influenced the intensity of intervention they were able to provide to children with phonology-based SSD.Conclusions & Implications: Insufficient detail in the reporting of intervention intensity within published research coupled with service delivery constraints may affect the implementation of empirical evidence into everyday clinical practice. Research investigating innovative solutions to service delivery challenges is needed to provide SLTs with evidence that is relevant and feasible for clinical practice

Communication rehabilitation in sub-Saharan Africa: A workforce profile of speech and language therapists.

BACKGROUND: There is an urgent global need to strengthen rehabilitation services for people with disabilities. In sub-Saharan Africa, rehabilitation services for people with communication disabilities continue to be underdeveloped. A first step in strengthening services for people with a communication disabilities is to understand the composition and conditions of the current workforce. OBJECTIVES: This research describes a sample of the speech and language therapists (SLTs) working in SSA (excluding South Africa). This study explores the characteristics of this workforce, including their demographics, education, experience and geographical stability. METHOD: A mixed-methods survey was used to collect data from SLTs within Anglophone countries of SSA. Completed surveys were received from 33 respondents working in 44 jobs across nine countries. Analysis included descriptive and non-parametric inferential statistics. This study reports on a subset of descriptive and quantitative data from the wider survey. RESULTS: A background profile of SLTs across the region is presented. Results indicated that the workforce of SLTs comprised a mix of local and international SLTs, with university-level education. Local SLTs were educated both within and outside of Africa, with more recent graduates trained in Africa. These data reflected the local emergence of speech and language therapy training in SSA. CONCLUSION: This sample comprised a mix of African and international SLTs, with indications of growing localisation of the workforce. Workforce localisation offers potential advantages of linguistic diversity and stability. Challenges including workforce support and developing culturally and contextually relevant SLT practices are discussed

Adverse Effects and Choice between the Injectable Agents Amikacin and Capreomycin in Multidrug-Resistant Tuberculosis

Background: The prolonged use of injectable agents in an MDR-TB regimen is recommended by the WHO despite association with ototoxicity and nephrotoxicity.Objective: We undertook this study to look at the relative adverse effects of capreomycin and amikacin.Methods: We reviewed the case notes of 100 consecutive patients treated at 4 MDR-TB treatment centres in the UK.Results: The median total duration of treatment with an injectable agent was 178 (IQR 109-192, n=73) days for those with MDR-TB, 179 (104-192, n=12) days for those with MDR-TB plus fluoroquinolone resistance and 558 (324-735, n=8) days for those with XDR-TB. Injectable use was longer for those started with capreomycin at 183 (IQR 123-197) days compared to 119 (IQR 83-177) days with amikacin (p=0.002). Excluding XDR-TB, 51 (51/85, 60%) patients were treated with an injectable for over 6 months and 12 (12/85, 14%) for over 8 months. 40 % of all patients discontinued the injectable due to hearing loss. 55% of patients experienced ototoxicity: 5 times (hazard ratio (HR) 5.2, CI 1.2-22.6, p=0.03) more likely in those started on amikacin compared to treatment with capreomycin only. Amikacin was associated with less hypokalemia than capreomycin (Odds ratios: 0.28 (0.11-0.72)), with 5 (5/37, 14%) patients stopping capreomycin due to recurrent electrolyte loss. There was no difference in the number experiencing a creatinine rise of > 1.5 times baseline.Conclusion: Hearing loss is frequent in this cohort, though significantly lower in those starting capreomycin which should be given greater consideration as a first line agent

How should children with speech sound disorders be classified? A review and critical evaluation of current classification systems

Background Children with speech sound disorders (SSD) form a heterogeneous group who differ in terms of the severity of their condition, underlying cause, speech errors, involvement of other aspects of the linguistic system and treatment response. To date there is no universal and agreed-upon classification system. Instead, a number of theoretically differing classification systems have been proposed based on either an aetiological (medical) approach, a descriptive–linguistic approach or a processing approach. Aims To describe and review the supporting evidence, and to provide a critical evaluation of the current childhood SSD classification systems. Methods & Procedures Descriptions of the major specific approaches to classification are reviewed and research papers supporting the reliability and validity of the systems are evaluated. Main Contribution Three specific paediatric SSD classification systems; the aetiologic-based Speech Disorders Classification System, the descriptive–linguistic Differential Diagnosis system, and the processing-based Psycholinguistic Framework are identified as potentially useful in classifying children with SSD into homogeneous subgroups. The Differential Diagnosis system has a growing body of empirical support from clinical population studies, across language error pattern studies and treatment efficacy studies. The Speech Disorders Classification System is currently a research tool with eight proposed subgroups. The Psycholinguistic Framework is a potential bridge to linking cause and surface level speech errors. Conclusions & Implications There is a need for a universally agreed-upon classification system that is useful to clinicians and researchers. The resulting classification system needs to be robust, reliable and valid. A universal classification system would allow for improved tailoring of treatments to subgroups of SSD which may, in turn, lead to improved treatment efficacy