Sarah Verdon

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.

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

Abstract 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.

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 childrens 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.

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 Childrens 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 SLPs 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 SLPs assessment of a multilingual Cantonese- and English-speaking 4-year-old boy. Resources are listed throughout the tutorial.

Mapping speech pathology services to developmentally vulnerable and at-risk communities using the Australian Early Development Census

Abstract Purpose: The Australian Early Development Census (AEDC) is a population-based measure of childrens development across five domains in the first year of formal schooling. In this study, the AEDC data from two domains (Language and Cognitive Skills and Communication Skills and General Knowledge) were used to explore the extent and distribution of vulnerability in communication skills among children in Australian communities. Speech Pathology Australia (SPA) membership data were then used to explore the accessibility of services within those communities. Method: The 2012 AEDC data were accessed for 289,973 children, living in 577 communities across Australia. The number of children identified as “at risk” (10–25th percentile) or developmentally “vulnerable” (< 10th percentile) in each of the domains was calculated, then the location of communities with high proportions (> 20%) of these children was determined. These data were mapped against the location of paediatric speech-language pathologists (SLPs) to identify the number of communities with little to no access to speech-language pathology services. Result: Across Australia, there were 47,636 children (17.4%) identified as developmentally vulnerable/at risk in Language and Cognitive Skills and 69,153 children (25.3%) in Communication Skills and General Knowledge. There were 27 communities with > 20% of children identified as developmentally vulnerable/at risk in Language and Cognition in their first year of formal schooling. Of those, none had access to speech-language pathology services, according to current SPA membership data. There were also 27 local government areas with > 20% of children identified as developmentally vulnerable/at risk in the Communication Skills and General Knowledge domain. Of these, three had access to SLP(s) and these were in regional/metropolitan areas. Conclusion: The AEDC provides a means of identifying communities where children are performing well and communities which may benefit from population-based prevention or intervention. Given the number of communities within Australia without access to SLPs, there is a need to reconsider how such population-based services could be delivered, particularly in the communities with higher levels of vulnerability in communication development.

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 worlds 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 Childrens 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.

Shared knowledge and mutual respect: Enhancing culturally competent practice through collaboration with families and communities:

Collaboration with families and communities has been identified as one of six overarching principles to speech and language therapists’ (SLTs’) engagement in culturally competent practice (Verdon et al., 2015a). The aim of this study was to describe SLTs’ collaboration with families and communities when engaging in practice to support the speech, language and communication of children from culturally and linguistically diverse backgrounds. The study also aimed to identify the benefits and tensions related to such collaborations and to describe opportunities for SLTs to enhance their cultural competence through collaborative practice. The current study drew upon three data sources collected during the ‘Embracing Diversity – Creating Equality’ study: field notes, narrative reflections by the researcher, and semi-structured interviews with SLTs. This study was conducted in 14 international sites across five countries (Brazil, Canada, Hong Kong, Italy and the USA), representing a diverse range of cultural and practice contexts. Cultural-Historical Activity Theory (CHAT, Engeström, 1987) was used as both an heuristic framework through which the study was conceptualized and as a tool for analysis to describe the varied nature of collaboration in different cultural contexts, the benefits of collaborating with families and communities, and the tensions that can arise when engaging in collaborative practice. The results illuminate the importance of SLTs’ collaboration with families in order to gain an understanding of different cultural expectations and approaches to family involvement, and to build partnerships with families to work towards common goals. Collaboration with communities was highlighted for its ability to both facilitate understanding of children’s cultural context and build respectful, reciprocal relationships that can act as a bridge to overcome often unspoken or invisible tensions arising in cross-cultural practice. The findings of this study highlight opportunities for professionals to enhance the cultural competence of their practice through engagement with families and communities.

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

Abstract 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.

Linguistic diversity among Australian children in the first 5 years of life

Abstract Like many English-dominant nations, Australia has a rich history of cultural and linguistic diversity. This diversity is the result of a melting pot of languages including languages spoken by Australias Indigenous people and languages added by European settlement and subsequent waves of migration from various parts of the world. Despite this rich history of linguistic diversity, little has been documented on the languages spoken by Australian children. The first three waves of data from 5107 children in the nationally representative Longitudinal Study of Australian Children were analyzed to consider language diversity among Australian children in the first 5 years of life. Data were collected from birth at 2-year intervals. At 0–1 year of age, 10.8% of children were reported to have a language other than English used as the main language in their home. When children were 2- to 3-years old, 16.7% were spoken to and/or used a language other than English, and 15.3% were spoken to and/or used a language other than English at 4–5 years of age. The most common languages spoken by Australian children when aged 4–5 years after English were Arabic, Italian, Greek, Spanish, and Vietnamese. Personal and environmental factors significantly associated with use of a language other than English at 4–5 years were parental use of a language other than English, and being a first- or second-generation migrant.

Awakening a critical consciousness among multidisciplinary professionals supporting culturally and linguistically diverse families: a pilot study on the impact of professional development

ABSTRACT In an increasingly globalised world there is need for professionals involved in providing services to children and families to be culturally competent. This pilot study explores the impact of attending a multidisciplinary professional development workshop based on the Six Principles of Culturally Competent Practice [Verdon, S. (2015a). Embracing diversity, creating equality: Supporting the speech, language and communication of culturally and linguistically diverse children (Unpublished doctoral thesis). Charles Sturt University, Bathurst, Australia] upon professionals’ cultural competence. There were 52 participants who completed pre-workshop questionnaires and post-workshop evaluations. Of these, two participated in in-depth follow-up interviews one year later to discuss the ongoing impact of professional development upon their practice. Pre-workshop, major challenges identified for working with culturally and linguistically diverse (CALD) families were cultural and language barriers, and working with interpreters. After completing the workshop, participants reported gaining knowledge about engaging in holistic practice, their personal cultural competence and the culture of families they worked with. Interviews conducted one year later revealed the workshop had an ongoing impact upon practice in four key areas: (1) knowing the family (2) organisational structures (3) collaborative practice and (4) the ongoing nature of cultural competence. This article discusses the complexities of teaching cultural competence, problematic issues in conceptualisation and the efficacy of such workshops in developing a critical consciousness among professionals to engage in culturally responsive practice with CALD families.