Lindy McAllister

A systematic review of the association between childhood speech impairment and participation across the lifespan

Speech impairment of unknown origin is one of the most common communication impairments in childhood. The purpose of this systematic review was to identify limitations in life activities that may be associated with speech impairment, through analysing the findings of papers published in the past 10 years. Domains from the Activities and Participation component of the International Classification of Functioning, Disability and Health were used as search terms, and resulted in 57 papers being identified. Findings from each paper were reviewed in terms of the association between speech impairment and Activity Limitations and/or Participation Restrictions as defined by the ICF. The systematic review revealed that speech impairment in childhood may be associated with the following Activity Limitations and/or Participation Restrictions: learning to read/reading, learning to write/writing, focusing attention and thinking, calculating, communication, mobility, self-care, relating to persons in authority, informal relationships with friends/peers, parent-child relationships, sibling relationships, school education, and acquiring, keeping and terminating a job.

Peer learning in clinical education

The purpose of this paper is to raise awareness of peer learning as a process that is potentially beneficial to clinical education. Peer learning is a well documented learning strategy in paediatric educational literature. Many allied health clinical education programs purport to utilize it as a learning technique. Do we really know what peer learning is, how to promote it and why it is beneficial to facilitate it? This paper addresses these questions by considering terminology and definitions of peer learning and briefly outlining theoretical justification for its use in clinical education. Literature regarding the application of peer learning in clinical education is reviewed and the reported and purported benefits of peer learning are discussed.

Changing practice: Implications of the World Report on Disability for responding to communication disability in under-served populations

Abstract The World Report on Disability provides a major challenge to the conceptualization and delivery of services for people with communication disabilities around the world. Many people, in both Majority and Minority World countries, receive limited or no support in relation to their communication disability. In this paper the prevalence of communication disability across the world (and the challenges to obtaining these data) are discussed, particularly in relation to disability more broadly. Populations that are under-served by speech-language pathology services in both Majority and Minority World countries are described. The paper describes organizational change theory and the potential it has, together with a biopsychosocial model of disability, to assist in understanding and influencing development of relevant services for people with communication disabilities (PWCD), particularly those who are under-served. Aspects of, and influences on, service delivery for PWCD are described. The need for novel ways of conceptualizing development of services, including population-based approaches, is highlighted. Finally, the challenges and opportunities for PWCD and for speech-language pathologists which arise from the nine recommendations of the World Report on Disability are considered and readers are encouraged to consider new and novel ways of developing equitable services for people with communication disabilities, in both majority and minority world settings.

Issues and innovations in clinical education

The provision of adequate, high quality clinical education for speech pathology students is becoming increasingly challenging, due to a range of changes and attitudes within all groups who have an interest in clinical education. Significant changes in speech pathology workplaces and employment patterns of speech pathologists, and concurrent changes in universities have created a situation of minor to extreme shortage of clinical placements in many countries. The appropriately high standards but sometimes prescriptive expectations of professional associations, accrediting bodies, and licensing or registration boards in some countries exacerbates the problems faced in developing alternative placement opportunities and supervision models. At both systemic and individual levels, some clinical educators hold on to beliefs and clinical education practices which are outmoded and impede the development of alternatives to the provision of clinical education. This article explores some of these issues, discusses some innovations in clinical education and challenges stakeholders to critique their positions and practices concerning clinical education.

Reflection in intercultural learning: examining the international experience through a critical incident approach

Professionals are increasingly being required to work in diverse, multicultural environments. Accordingly, skills in intercultural practice are a prerequisite to professional knowledge and competence. Ensuring that these are developed is increasingly part of the core business of universities. Currently, however, there is a gap in the knowledge base as to the learning processes that underpin the acquisition of such intercultural understandings, knowledge and competence. This article represents an attempt to address this gap through describing some of the findings of a qualitative, interdisciplinary study undertaken by the authors with students at Charles Sturt University, Australia. The purpose of the study was to illuminate key processes in the development of cultural knowledge and intercultural competence through exploring the experiences of education and health professional students undertaking fieldwork and study in Indonesia and Vietnam. In this article we illustrate and discuss a continuum of learning to be interculturally competent, grounded in the data, and conclude with a series of recommendations for future practice and research.

The impact of speech impairment in early childhood: Investigating parents' and speech-language pathologists' perspectives using the ICF-CY

PURPOSE To explore the application of the Activities and Participation component of the International Classification of Functioning, Disability and Health - Children and Youth (ICF-CY, World Health Organization, 2007) as a framework for investigating the perceived impact of speech impairment in childhood. METHOD A 32-item questionnaire based on six ICF-CY domains was distributed to (a) a national sample of speech-language pathologists (SLPs; n=205), and (b) parents (n=86) of preschool children identified with speech impairment. RESULTS Factor analysis of the SLP data revealed six coherent factors with moderate-high internal reliability: Verbal communication (e.g., Conversation, Speaking), Advanced learning (e.g., Learning to read/write), Interpersonal interactions (e.g., Relating with strangers, Informal social relationships), Basic learning (e.g., Copying, Rehearsing), Applied learning and general tasks (e.g., Focussing attention, Handling stress), and Non-verbal communication. The first five factors were also confirmed by the parent data. Both SLPs and parents rated the first two factors, Verbal communication and Interpersonal interactions, as the most difficult activities for children with speech impairment. CONCLUSION The ICF-CY Activities and Participation component is a useful framework for considering the breadth of activities that may be impacted by speech impairment in childhood. LEARNING OUTCOMES (1) Discuss the potential use of the ICF-CY in speech-language pathology; (2) Describe the breadth of activities that may be difficult for children as a result of speech impairment; and (3) Recognize that SLPs and parents may have different perspectives regarding the impact of speech impairment on childrens activities and participation.

Educating clinical educators: using a model of the experience of being a clinical educator

Background: Clinical educators are expected to prepare students to be competent beginning practitioners, ready to enter the workforce and meet the demands of competent practice. As part of ensuring the quality of clinical education, universities that provide these programs need to be involved in the education and support of clinical educators. In this paper we examine the preparation and professional development of clinical educators based on research into the experiences of being a clinical educator (McAllister 2001). Methods: The research approach involved a blend of hermeneutic phenomenology and narrative inquiry. In-depth interviews were conducted with five speech pathologists in Australia. Data were analysed using a phenomenological analysis process. Results: Recurrent themes in the research were represented by 12 themed stories to richly portray participants’ experiences of being clinical educators. An example is provided in this paper. The research produced a model of The Experience of Being a Clinical Educator. The six dimensions of this model are: a sense of self, of self-identity; a sense of relationship with others; a sense of being a clinical educator; a sense of agency or purposeful action; dynamic self-congruence; and the experience of growth and change. Conclusion: Becoming and being a clinical educator is a developmental process, mirroring in some ways the developmental process clinical educators strive to facilitate for their students. This journey of growth and development as a clinical educator requires active learning approaches coupled with reflection on ones practice as a clinical educator. The model can be used to educate clinical educators in speech pathology and other professions, given the commonalities in clinical educators’ roles across professions. Interactive and reflective strategies are presented in the paper for the development and support of clinical educators across the continuum from novice to professional artist.

The lived experiences of clinical educators with implications for their preparation, support and professional development

The article reports on research into the lived experience of being and becoming a speech pathology clinical educator, and examines implications for the preparation and professional development of clinical educators. The Lived Experience of Being a Clinical Educator Model offers valuable insights into the nature of the role and the realities of clinical educators’ lives. The model comprises six dimensions of being a clinical educator: a sense of self; a sense of relationship with others; a sense of being a clinical educator; a sense of agency; an endeavour to seek dynamic self-congruence; and growth and development. The model will provide a sound basis for the preparation and professional development of clinical educators, as well as being a useful tool for personally reflecting upon their challenging role as practitioners.

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

The World Health Organizations 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.

Interprofessional supervision in an intercultural context : a qualitative study

Our understanding of the qualities and value of clinical supervision is based on uniprofessional clinical education models. There is little research regarding the role and qualities needed in the supervisor role for supporting interprofessional placements. This paper reports the views and perceptions of medical and allied heath students and supervisors on the characteristics of clinical supervision in an interprofessional, international context. A qualitative case study was used involving semi-structured interviews of eight health professional students and four clinical supervisors before and after an interprofessional, international clinical placement. Our findings suggest that supervision from educators whose profession differs from that of the students can be a beneficial and rewarding experience leading to the use of alternative learning strategies. Although all participants valued interprofessional supervision, there was agreement that profession-specific supervision was required throughout the placement. Further research is required to understand this view as interprofessional education aims to prepare graduates for collaborative practice where they may work in teams supervised by staff whose profession may differ from their own.