People with post-stroke aphasia are at risk of depression and social isolation. This study suggests that speech and languagetherapists overwhelmingly consider the psychosocial well- being of their clients, engage in supportive listening and set holistic and social goals in collaboration with the person with aphasia. It is of concern, however, that the majority of SLTs lack confidence in addressing psychological distress, as well as skills and ongoing support for this work. A further concern is that mental health professionals are perceived to be underprepared for working with people with aphasia. Services need to ensure that the psychological well-being of people with both mild and severe aphasia is addressed, and that mental health services are accessible to this client group.
Closely linked to the psychological consequences are the social consequences of having a stroke: in a recent systematic review, poor social support was significantly associated with depression in 13/14 stroke studies (Northcott, Moss, Harrison, & Hilari, 2015). Language loss appears to present particular challenges in maintaining a diverse social network post stroke (Northcott, Marshall, et al., 2016), as well as profoundly impacting upon family dynamics (Fotiadou, Northcott, Chatzidaki, & Hilari, 2014; Winkler, Bedford, Northcott, & Hilari, 2014). Activity and participation goals which recognise the social context of communication are among people with aphasia’s top priorities and have increasingly been incorporated into conceptions of SLT best practice (Royal College of Speech and LanguageTherapists, 2005; Wallace et al., 2016). A further aim was to explore how SLTs experience working towards social goals, and how they position remediating the language impairment within these broader psychosocial aims.
In Australia, as in the UK, the majority of speech and languagetherapists (SLTs) are employed by Health Departments (Health Workforce Australia, 2014), while teachers are employed by Education Departments. In order for most school-aged children to receive school- based speech-language therapy services, they need to be eligible for funding. This funding is allocated on the basis of their presenting difficulties and is provided to schools to enable them to employ SLTs to support the needs of the funded children. Legislation and policies regarding funding and service provision for children with SLCN vary from one state to the next. For instance, in Victoria, the second most populous state in Australia, children need to present with language skills at least 3 standard deviations below the mean (0.1% of the population) in order to receive funding, while in New South Wales, the most populous state, students with SLCN are not specifically included in criteria to receive individualised funding (McLeod et al., 2010). As a result, some families seek private speech-language therapy services instead, the cost of which can be prohibitive for many families (Senate Community Affairs Committee Secretariat, 2014).
This study investigated predictors of decisions made by speech and languagetherapists (SLTs) to offer intervention for a pre-school child and the children’s outcomes relative to that decision. The study uses data from 347 children who were first assessed aged under 3 years 6 months by community speech and languagetherapists in the UK. Of these, 158 were offered therapy, 189 were either discharged or offered only monitoring appointments. After adjusting for the child’s age and gender, six variables were significantly associated with the therapist’s original decision: being a quiet baby, not using two word utterances or making comments on their play, being unintelligible to strangers and the child’s score on auditory comprehension and expressive language scales of the Preschool Language Scale. These show a focus on communication variables rather than broader demographic and medical variables. At follow-up, aged 7-9 years, 56% of the children were available for re-assessment. Therapists’ decisions at initial assessment show a sensitivity of 0.85 and a specificity of 0.61 relative to children’s outcomes. Of the 191 children seen at follow-up, 21 were deemed to have ongoing difficulties.
Because the study by Moran et al. (2005) included only four speech and languagetherapists, very limited information specifically about the migrant speech and language therapist’s experience is available. Data acquired from the Health Professions Council 2 (HPC) suggests that the speech and language therapy (SLT) workforce in the UK does include migrant workers. While exact statistics for the profile of the current workforce are not available, the HPC does collect data on whether first time registrants obtained their qualification in the UK or overseas. From 2002-2008, an average of 180 overseas qualified speech and languagetherapists have registered with HPC, compared to an average 705 UK qualified therapists (HPC personal communication). For exact values for each year please see figure 1. The process and requirements for HPC registration for overseas qualified speech and languagetherapists are publically available (see http://www.hpc-
In contrast to other professions working in rehabil- itation (Rosewilliam et al. 2011, Lawton et al. 2016) communication impairment was not seen as a major barrier to establishing a connection because of thera- pists’ perceived understanding of aphasia and enhanced communication skills. Similarly, speech and languagetherapists in Hersh’s study (2010: 289) perceived that they were in a unique position as they were often the only person to be able to forge a ‘real relationship’, pre- cisely because of their communication skills. Commu- nication impairment was, however, thought to impact on the degree of collaboration and subsequent ability to reach consensus, supporting findings from earlier sys- tematic reviews (Lawton et al. 2016, Rosewilliam et al. 2011). Conversely, Rohde et al. (2012) were able to elicit goals from participants (people with aphasia) engaging in aphasia rehabilitation, where speech and languagetherapists had reportedly been unsuccessful. Therefore, the authors contended that it was not, in fact, the com- munication impairment that was constraining collabo- ration, but instead ascribed this lack of collaboration to; the therapists’ priorities and value systems; a service de- livery model prioritizing an impairment based approach and constraining time; lack of supportive communica- tion skills and materials; and the client’s reluctance to participate. Indeed, a number of studies have shown that even people with moderate to severe linguistic im- pairments and cognitive impairment can be included in goal setting with the use of pictorial resources, such as talking mats (Bornman and Murphy 2006), life interest and values cards (Haley et al. 2013). Goal collaboration, it would seem, is certainly possible for many people with aphasia but is reliant on the therapist’s skill, time resources and the patient’s desire to participate.
Citation: Northcott, S., Simpson, A., Moss, B., Ahmed, N. and Hilari, K. (2017). How do Speech and LanguageTherapists address the psychosocial well-being of people with aphasia? Results of a UK on-line survey. International Journal of Language and Communication Disorders, 52(3), pp. 356-373. doi: 10.1111/1460-6984.12278
Abstract Medical and paramedical treatments should be evaluated according to current standards of evidence-based medicine. Evaluation of therapy in oropharyngeal dys- phagia fits into this growing interest. A systematic review is given of the literature on the effects of therapy in oro- pharyngeal dysphagia carried out by speechtherapists. Thus, the review excludes reports of surgical or pharma- cological treatments. The literature search was performed using the electronic databases PubMed and Embase. All available inclusion dates up to November 2008 were used. The search was limited to English, German, French, Spanish, and Dutch publications. MESH terms were sup- plemented by using free-text words (for the period after January 2005). Fifty-nine studies were included. In general, statistically significant positive therapy effects were found. However, the number of papers was rather small. More- over, diverse methodological problems were found in many of these studies. For most studies, the conclusions could not be generalized; comparison was hindered by the range of diagnoses, types of therapies, and evaluation techniques. Many questions remain about the effects of therapy in oropharyngeal dysphagia as performed by speech and languagetherapists. Although some positive significant outcome studies have been published, further research based on randomized controlled trials is needed.
the USA, all identified reports were of services delivered in the UK. This suggests that, within the UK, a substantial amount of practice has taken place within the context of Sure Start local programmes. No purely family focussed health promotion services for early language development were identified on the Communication Trust’s “What works” website, although 6 were identified from the “Centre for Excellence in Outcomes” (C4EO) website. The “What works” website is specific to speech and language therapy interventions, whereas the C4EO website provides information on a range of children’s services. Fourteen reports were selected from the Royal College of Speech and Languagetherapists’ monthly magazine, the Bulletin. A further five studies were identified from conference reports and one study was communicated personally as a result of the call for information. A number of reports highlighted more than one service, resulting in a greater number of services identified than reports.
A number of surveys of SLTs views have been conducted. Several have asked about specific and relatively circumscribed topics. For instance, Vallino-Napoli and Reilly (2004) found that Australian therapists valued research and that most were aware of evidence based practice but that lack of time prevented them from using evidence or contributing to research. Others have looked at the recruitment and retention of SLTs’ and their job satisfaction and career progression (ASHA, 2008; Loan-Clarke et al, 2009; Rossiter, 2008). Findings are of a high level of retention encouraged by the positive nature of the work, job and pension security and the opportunities for training and career progression. Those leaving mentioned the high work load, stress and poor pay. Watts Pappas et al. (2008), again surveying Australian therapists, found that the service for children with speech disorders often involved parents in the delivery of therapy but rarely in planning treatment and that a minority had significant reservations about the role of parents. Dockrell et al (2006) asked SLT managers about service delivery and educational provision for children with language disorders. Prominent themes within their findings are the lack of a common terminology to guide decision making and the increasing trend towards indirect therapy by teaching assistants and other professionals. Clinicians are
The main professionals working with children and young people with SLCN are teachers, teaching assistants, early years practitioners, and speech and languagetherapists (SLTs). Recently a substantial programme aimed at increasing the knowledge, skills, attitudes and confidence of teachers to support pupils with SEN was funded by the DfE. The programme included a focus on pupils with SLCN and those with ASD. Separate support materials were developed for those in initial teacher training (ITT) and qualified teachers. Dissemination and embedding in schools was assisted by a support system of regional hubs and local leaders; a similar system for ITT was also set up. Other initiatives included special school placements for trainee teachers. This was a unique and successful national initiative to enhance the capability of the teacher workforce to support pupils with SLCN, ASD and other special educational needs 46 .
The research evidence for speech and language therapy interventions for PPA is sparse and is predominantly lim- ited to naming therapies, word finding difficulty being a common impairment [5–11]. However, naming is often not the main limitation on communication function in PPA, and interventions are required to address real world communication function. This is particularly relevant given that prognosis in PPA is for loss of function, rather than improvement as in stroke aphasia, and there is a need to engage family/carers in speech and language ther- apy. Yet, there is a paucity of literature examining the im- pact that speech and languagetherapists (SLTs) can have in supporting a person with PPA and their family/carers with conversation [12, 13]. Nevertheless, SLTs in clinical practice report using communication training programs more often than naming therapies . This is not sur- prising when reports suggest many patients disengage from naming therapies due to the frustration of practising individual words they will inevitably lose as the disease progresses .
This study explored the perspectives of 38 individuals who live with or work with aphasia, incorporating the views of three stakeholder groups: 14 individuals with aphasia, 14 family members, and 10 speech and languagetherapists (see Participants section below for further information). All participants with aphasia were recruited and assessed by the first author at the Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal. In order to obtain as much information as possible from participants a qualitative approach was deemed appropriate. Focus groups were used with some participants. In-depth semi-structured interviews were used with other participants. Interviews were carried out in groups or individually in order to accommodate severe aphasic impairments, or respondents with fewer years of education 1 . Interviews were video-recorded and transcribed verbatim was produced. The transcripts were analysed using content analysis, more specifically thematic analysis (Bardin, 1977; Berelson, 1971). Interviews with PWA and FM explored questions related with the impact of stroke and aphasia in their daily lives in terms of: disability and functionality; satisfaction level with social participation; changes they would like to introduce in their lives. A topic guide was used (see appendix 1). Focus group with SLTs explored questions such as: What are the consequences of stroke in the lives of those whom you work with? What are the consequences of aphasia in the lives of those whom you work with? What are the activities they actually do? What are the activities they usually refer as not doing anymore after stroke and aphasia? How do they participate in society? All interviews were conducted in European Portuguese (EP).
In order to ensure that progress in shared aims is maintained and achieved, building an effective professional relationship based on mutual respect is fundamental. The values of carers and SLTs may not be aligned which means that the SLT must adopt a problem-solving approach and consider therapeutic goals more broadly; training and modelling should be a significant part of intervention (Royal College of Speech and LanguageTherapists (RCSLT), 2006), ideally involving the service-user as well as the SLT and carer:
Building understanding of professional roles is a common learning outcome for health- based IPE (Thistlethwaite & Moran, 2010). For instance, two prevalent IPE competency frameworks developed for health-based initiatives include understanding of professional roles as a critical competency for inter-professional collaboration (Canadian Interprofessional Health Collaborative, 2010; Interprofessional Education Collaborative Expert Panel, 2011). Similarly, a study which utilised interview analysis with health-care workers (n=60) also revealed that role understanding was one of the competencies which they considered most relevant to effective co-working (Suter et al., 2009). More specifically, role understanding has been described as necessary for meaningful inter-professional communication (Suter et al., 2009). Further, role understanding facilitates appropriate use of practitioners’ services by helping them understand which professional has the knowledge and skills best suited to address a particular problem (Canadian Interprofessional Health Collaborative, 2010). This was evidenced in the current study by student teachers’ comments of possessing a better understanding of when to access SLT services. Similarly, the IPE prompted some student SLTs to consider how classroom teachers’ skills can be utilised to support children who experience speech, language and/or literacy difficulties. Without this IPE experience, many participants may not have opportunity to develop even these cursory understandings of professional roles, given that current models of professional study offer limited inter-professional learning opportunities (as supported by the survey study in Chapter 2). The current findings thus suggest that the IPE was a valuable experience that made a unique contribution towards preparing participants for collaborative practice.
The term SLCN is used in two different ways in educational contexts. The Bercow Review used SLCN as a broad and inclusive term to cover all children with speech, language and communication needs including those with primary difficulties with speech, language and communication and also those whose needs are secondary to other developmental factors such as hearing impairment or cognitive impairment. This breadth of use is not consistent with the classification systems used by the DfE to classify special educational needs where SLCN has a narrower primary focus on language and excludes children with ASD, sensory, more general cognitive difficulties, or primary behaviour difficulties. Researchers and speech and languagetherapists (SLTs) describe a further cohort of children – those with specific language impairment (SLI) which is, effectively a subset of the children within the narrower SLCN category. These children are defined as having a primary language difficulty which is not associated with any other developmental difficulty including autism, hearing impairment or other neuro-developmental impairment and whose nonverbal ability is within the average
Aim: To carry out an audit of the quantity and content of research teaching on UK pre- registration speech and language therapy degree programmes. Method: Lecturers delivering research teaching from each higher education institution providing pre-registration training were invited to complete an online survey. Questions included: amount of research teaching, content of research teaching (including final year projects), perceived confidence by staff of graduates in research awareness, research activity and leading research. Responses were received for 14 programmes (10 undergraduate and 4 postgraduate), representing 73% of all undergraduate courses and 44% of all postgraduate courses in the UK.
respond with what could be described as draconian decisions to exclude the new media altogether for as long as they can. Some reveal feeling guilty that their children do use new media, such as videogames. Speech and languagetherapists (henceforth, SLTs), educational psychologists and teachers tell us that they are frequently asked for advice on whether the media are harmful and what can be done about them. But these professionals often feel uncertain as to what to say. They feel (a) they already have much to discuss and to do with the children and the families under their care, and (b) they have rarely been trained in the developmental psychology of children‘s media uses. In their turn, they would welcome advice on what to advise. The purposes of this article are to illuminate some of the key issues and to review the implications of different types of advice that might be offered to caregivers.
In working in partnership with teachers in this way Jo and Bib confirmed their basic premise; that the teachers’ knowledge for effective pedagogies might be enhanced by drawing on the specific expertise that they held because of their own professional expertise as speech and languagetherapists. They found the training and coaching to be a means to support teachers’ professional learning which was suited to the complex and particular contexts in which they worked. Through our action research and using the Theory of Change approach we were able to demonstrate that this form of coaching can bring speech and language therapy research and expertise into the practice domain of teachers. I will share some details of how this changed practice and allowed participants to develop new understandings in a short while. For now, I want to emphasise that this was a dynamic, reciprocal and co-constructive relationship through which both parties, from the two professions, extended their knowledge base and developed a more nuanced understanding of relevant evidence for, and in, practice. I offer this case study, not as an excuse to focus on my enthusiasm for coaching, but as a way to explore inter-professional learning.