Children's drawings of intervention for childhood apraxia of speech: Place, people, activity, and emotion

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. To report scope and critically appraise evidence of family-focused health-promotion practice for early language development in this area. 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. 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. 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.

Despite the high prevalence of bilingualism in the United Kingdom, few speech and language therapists (SLTs) are bilingual themselves. Most SLT research on bilingualism has generated knowledge to inform service delivery for bilingual clients, but few studies have investigated how being a bilingual SLT influences one's professional experiences and practices. Better understanding the unique positionality of bilingual SLTs can yield critical insights to meaningfully address issues of diversity, inclusion and equity in the profession. To investigate the experiences and practices of bilingual paediatric SLTs in the United Kingdom through the lens of Cultural-Historical Activity Theory-International Classification of Functioning, Disability and Health (CHAT-ICF), a new theoretical framework developed to conceptualise the activities of professionals working in the field of disability. In this qualitative study, 19 bilingual paediatric SLTs practising in the United Kingdom were interviewed individually. Participants were recruited through a snowball sampling strategy, and semi-structured interviews conducted online. The data were analysed using reflexive thematic analysis and following a hybrid inductive-deductive approach to map the results onto the CHAT-ICF framework. Six overarching components of the CHAT-ICF framework hosted the 12 sub-themes identified to capture the experiences and practices of bilingual SLTs: (1) Subject (intersectionality); (2) Tools (language skills, education, clinical resources); (3) Rules (systemic barriers, sense of responsibility); (4) Community (sense of inclusion); (5) Division of labour (parents, colleagues); and (6) Practice (empathy with children, holistic mindset, flexible approaches). The use of the CHAT-ICF theoretical lens revealed two fundamental structural phenomena: (1) the distribution of sub-themes across many components of CHAT-ICF demonstrated that being a bilingual SLT is a multifactorial experience; and (2) the chain reactions between sub-themes illustrated the dynamic nature of bilingual SLTs' experiences which can be harnessed to challenge marginalisation and promote equity in the profession. This is the first qualitative study to date to provide in-depth insights into the experiences and practices of bilingual SLTs in the United Kingdom. These insights can be mobilised to inform the meaningful inclusion of bilingual SLTs in workforce planning efforts and service development. Recommendations include using intersectional lenses, providing cultural and anti-racism awareness training to SLTs, developing more diverse clinical resources and flexible approaches for bilingual families, valuing bilingualism in recruitment processes and increasing accountability at the leadership level. Research giving voice to bilingual SLTs, and other underrepresented demographics in the SLT workforce, can catalyse action to promote a more diverse and inclusive profession in line with the Royal College of Speech and Language Therapists' strategic vision 2022-2027. What is already known on the subject Most research on bilingualism in speech and language therapy is focused on issues related to service provision and delivery for bilingual clients with little consideration for bilingual speech and language therapists' (SLTs) unique positionality. A few survey studies have shown that bilingual SLTs report significantly higher competency and greater confidence when working with clients who speak multiple languages, but there are significant gaps in understanding how bilingualism impacts other aspects of their professional experiences. What this paper adds to existing knowledge This is the first study to provide in-depth insights into the experiences and practices of bilingual SLTs in the United Kingdom. We show that being bilingual profoundly impacts many aspects of their professional experiences, including their clinical identity, skillset, sense of inclusion in the workplace, work relationships and clinical approaches. Bilingual SLTs expressed developing trust relationships with bilingual families and adopting flexible approaches to account for their clients' environmental factors, all of which can contribute to more equitable SLT services. This study also makes a novel contribution by proposing and using the Cultural-Historical Activity Theory-International Classification of Functioning, Disability and Health (CHAT-ICF) framework to conceptualise and investigate SLTs' experiences and practices. What are the potential or actual clinical implications of this work? This study provides evidence-based recommendations to inform progress towards the Royal College of Speech and Language Therapists' strategic vision 2022-2027 and the diversification of the profession. Actions to support bilingual SLTs and diversify the profession include shifting a rigid mindset of linguistic and cultural `competence' to self-growth and awareness, developing more diverse clinical resources and flexible approaches for bilingual families, valuing bilingualism in SLT recruitment processes and career progression and increasing accountability and leadership around issues of diversity in the workplace. The novel CHAT-ICF framework has the potential to be used to support therapists' reflexivity in their practice or structure audits of rehabilitation services. Intersectionality theories and transformative processes can catalyse positive change in clinical services and research around bilingualism.

Objective: Clinical guidelines place considerable emphasis on early swallow screening, as it has significant impact on patient outcomes. This study aims to examine perspectives and practices of speech and language therapists (SLTs) in the Republic of Ireland on swallow screening, exploring challenges in screening methods to improve practice and facilitate research. Methods: An 18-item web-based survey was devised targeting SLTs working in dysphagia in Republic of Ireland. Perspectives were sought on definitions of screening, models of practice, tests used, and factors influencing decision-making. Results: Fifty-eight SLTs responded, representing a cross section of clinical settings, populations, and experience. Screening tests most frequently employed were personal screening tests (80%). Important considerations reported in test selection were patient safety (100%), ease of use (97%), staffing (97.5%), and diagnostic accuracy (97.5%). Perceived challenges were staff training associated with screening. Conclusions: It is concerning that while diagnostic accuracy was recognised as important, most respondents used tests lacking in diagnostic accuracy. While the survey response rate was low, it is hypothesised that findings reflect practice. There is a need for SLTs to equip themselves with the skills to discern which screening test is most diagnostically accurate for clinical populations with further research to improve practice.

ABSTRACTIntroductionPrioritisation is an important and necessary practice in speech and language therapy (SLT) departments, as the increasing demand for services often exceeds available resources. Despite being a key clinical activity within the profession, however, there is limited research on evidence‐based methods for prioritisation systems (PS) used in adult SLT settings. As a result, the absence of standardised guidelines poses a risk of inconsistency in current prioritisation practices. This may lead to an unequal distribution of resources, potentially affecting patient well‐being and outcomes.MethodsA scoping review was carried out which aimed to identify the PS used in adult SLT settings and to determine the facilitators and barriers to the development and implementation of effective PS in these settings. This study was conducted in line with PRISMA‐ScR guidelines, with a protocol prospectively published (https://osf.io/dbtsf/). Six academic databases, three professional body websites, and two national health service websites were searched using a multi‐tiered search strategy with assistance from a subject expert librarian. Data was charted regarding outcomes of interest, and critical appraisal using study design‐specific tools was completed by two independent researchers.ResultsOf the 10 studies eligible for inclusion, 60% identified dysphagia as a high priority for earliest intervention, with 30% consistently prioritising dysphagia over any communication deficits due to the medical implications of unmanaged swallowing problems. The majority did not address facilitators (60%) or barriers (80%) to developing or implementing PS. The absence of a standardised prioritisation system was noted throughout the included studies, with clinical judgement alone, non‐standardised systems, or chronological order of referral commonly used in prioritisation.ConclusionThis scoping review examines the limited existing literature on PS in adult SLT settings, noting the lack of evidence‐based or standardised systems. Further research is now needed to identify the critical factors which influence a clinician's prioritisation process prior to ultimately conducting subsequent research into the facilitators and barriers to developing and implementing evidence‐based PS in order to establish best practices to improve patient care, experiences, and outcomes.WHAT THIS PAPER ADDSWhat is already known on this subjectCaseload prioritisation decisions are often made by individual speech and language therapists (SLTs) (Foster et al. 2014), and this can compromise the fair distribution of the allocation of resources. A lack of reliability and subjectivity are barriers to the use of prioritisation systems (PS) in healthcare settings (McRae et al. 2021). Subjectivity in prioritisation decisions impacts consistency across different settings, as therapists in different settings may have different interpretations of the criteria for various priority levels (Rice 1998).What this paper adds to existing knowledgePrioritisation practices in speech and language therapy services vary, and to date, a systematic search of the published literature on PS in adult speech and language therapy settings has not been published. This study provides a comprehensive overview of the literature on PS used in adult speech and language therapy settings.What are the potential or actual clinical implications of this work?A core finding of this review was the lack of available information regarding the specific details of PS used in practice or facilitators and barriers to the development and implementation of effective SLT PS within real‐life clinical settings. The lack of available explicit information hinders development in the field of SLT, as settings cannot learn from the experience of others and share knowledge regarding the profiling and overcoming of barriers, thus reducing opportunities for growth and ingraining unstandardised practices. There is a demand for development in this area, thus further highlighting the research gap and subsequent real‐life clinical implications.

Children with language disorder frequently experience difficulties with vocabulary acquisition, and these difficulties often persist into adolescence. The literature indicates that clinical studies tend to investigate phonological-semantic approaches, whereas educational studies focus on the derivation of meaning within a literacy context. Little is known about whether the practices of speech and language therapists and teachers reflect these findings from the literature. The current paper reports on a survey which gathered information from speech and language therapists and mainstream secondary school teachers, about their current practice concerning vocabulary support for adolescents, aged 11–16, who have language disorder. An online questionnaire was distributed through teaching and speech and language therapy professional networks. The aim of the study was to establish which specific strategies were used in practice by speech and language therapists and mainstream secondary school teachers to teach vocabulary to adolescents with language disorder, and which strategies were the most effective. Responses were obtained from 127 speech and language therapists and 47 mainstream secondary school teachers in the UK. Speech and language therapists were more likely than mainstream secondary school teachers to teach phonological awareness and semantic feature analysis as strategies for developing vocabulary skills. Both professions used literacy-related strategies as well as strategies for independent word learning such as the derivation of meaning from morphology and context. Increased joint working and training opportunities would further develop the knowledge and skills of both mainstream secondary school teachers and speech and language therapists, enabling theoretically-grounded and relevant vocabulary support for this group of adolescents.

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. To investigate the working practices and professional experiences of paediatric SLTs working in the UK through an online survey. 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. 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. 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.

Meeting the needs of children with specific speech and language difficulties (SSLD) has recently been an area of public policy concern, because of the difficulties in securing speech and language therapy for children with special educational needs (SEN). There is a clear need for education and health service staff working together to support children with speech and language difficulties.The present research involved case studies of six English local authorities (LAs), along with the eight speech and language therapy services provided by the relevant local health trust. They were chosen as examples of good practice in education and health services working together, on the basis of information provided during a previous national study. The purpose of the research was to explore the collaborative practice of educational psychologists (EPs) and speech and language therapists (SLTs) with respect to the education of children with SSLD.This paper reports the views of 51 EPs and 120 SLTs, who worked in the case study LAs with respect to: collaboration; approach to assessment; provision; monitoring of progress; training and views on good practice. Despite the positive regard for collaboration expressed by both EPs and SLTs, their practice revealed little evidence of this occurring. Differences in approach, including the use of assessments for diagnostic purposes and the preference for inclusive as opposed to specialist provision, revealed important differences in conceptualisation between EPs and SLTs. The paper argues that these must be addressed so that collaborative practice by EPs and SLTs may be used not only to developgoodpractice but also to improve outcomes for children byeffectivepractice.

OBJETIVO: verificar se os critérios adotados no Modelo Linguístico Fuzzy, para classificar a gravidade do Desvio Fonológico (DF), são empregados na prática fonoaudiológica e se estão de acordo com a finalidade do Modelo. Além disso, analisar a concordância entre a gravidade do DF classificada pelo Modelo e a julgada por fonoaudiólogas, bem como, verificar as principais dificuldades. MÉTODO: a pesquisa foi constituída por duas amostras. A primeira composta por um número representativo de sistemas fonológicos desviantes (n=52) classificados pelo Modelo quando o mesmo foi proposto. A segunda por dois grupos de fonoaudiólogas GF-I e GF-II. Foi solicitado que as fonoaudiólogas julgassem a gravidade dos sistemas fonológicos desviantes, mapeados no Modelo Implicacional de Complexidade de Traços - MICT, em Grave, Moderado-Grave, Moderado-Leve e Leve. Em seguida os critérios e as principais dificuldades foram descritas em um questionário. Empregou-se a Estatística Kappa, com nível de significância de p<0,05. RESULTADOS: os critérios utilizados na proposta, em geral, foram utilizados pelo GF-I e julgados adequados pelo GF-II. Verificou-se concordância entre a classificação da gravidade obtida pelo Modelo com a julgada pelas fonoaudiólogas. Quanto às dificuldades, a frequentemente relatada foi diferenciar graus intermediários. CONCLUSÕES: os critérios utilizados no Modelo Linguístico Fuzzy são empregados para classificar a gravidade do DF quando realizada com base no MICT. Além disso, os critérios empregados estão de acordo, cumprindo com a finalidade do Modelo. Diante das dificuldades, outras formas de classificar a gravidade podem ser agregadas a fim de caracterizar o DF sobre outros aspectos importantes.

BACKGROUND: COVID-19 accelerated telepractice implementation in speech and language therapy (SLT) in Ireland. OBJECTIVE: This study documents the service delivery changes that took place in the SLT profession in Ireland during the public health crisis. METHODS: An online survey of speech and language therapists (SLTs) in Ireland was conducted from June-September 2020 to investigate their perceptions of telepractice. Data were analysed using descriptive and inferential statistics and frequency distribution. RESULTS: 173 SLT responses were analysed. Over half of the participants worked in urban locations. Respondents’ years of experience varied from less than four years to over 20 years. Slightly over half the participants reported using telepractice, with 85% starting to use telepractice in the six months prior to the survey. Telepractice uptake was not influenced by participants’ professional experience or geographical location (p > 0.05). Almost all participants who used telepractice were trained informally (92%). Telepractice was most commonly used with school-aged children with developmental language and speech sound disorders. Respondents perceived that telepractice was not suitable for all individuals who need SLT, including those with complex needs. Clinicians reported that telepractice facilitated access to therapy for clients and opportunities to see clients in their own environments. Technology barriers were the biggest hurdle to telepractice use. CONCLUSIONS: Uptake of telepractice by the SLT profession in Ireland was widespread during COVID-19, highlighting the profession’s flexibility and innovation. Respondents indicated they are likely to continue to use telepractice as a complementary service delivery model post-COVID due to the distinct benefits for clinicians and clients.

Objective Communication is fundamental to mental health services for every patient, caregiver and clinician interaction. Without adequate communication skills, the aspiration to inclusion, engagement and recovery is likely to fail. Speech and language therapists provide specialist knowledge directly with patients, and indirectly via clinicians and caregivers. The objective of this study was to explore current UK provision and practice of speech and language therapists supporting working age adults with mental health conditions. Method A ten question online survey was shared on social media and sent to a network of speech and language therapists interested in mental health services in September 2019. Responses were analysed using descriptive statistics supported by free text survey responses. Results From survey closing in March 2020, 96 responses were received from across the four UK nations describing widely varying services. Respondents reported concerning gaps in SLT provision, other professions not understanding the SLT role, but over 75% of respondents reported multidisciplinary ways of working. Discussion Risks associated with communication impairment are often overlooked. The understanding of mental health professionals about the role of speech and language therapists is patchy. Highlighting awareness amongst the mental health workforce about communication impairment will improve access to treatment and care for all patients.

The concept of evidence-based practice (EBP) increasingly influences all areas and professions of health care and hence the field of speech and language therapy. In order to establish EBP in the practice of speech and language therapists, it has to become an obligatory element of the curriculum. In the English literature, an intensive debate about educational standards and curricula is already taking place. The aim of this article is to stimulate the discussion in German-speaking countries. It is discussed, which kind of knowledge and which skills have to be imparted and how these elements could be anchored within the education of speech and language therapists. In particular, a blended learning module is described, which introduces EBP to undergraduate students. This learning module is evaluated in a pilot study within a sample of 39 students of speech and language therapy. Finally, it is discussed which steps should be taken in German-speaking countries to advance educational concepts concerning EBP for speech and language therapists.

BackgroundNon-progressive dysarthria is an acquired motor speech disorder resulting from neurological diseases such as stroke and traumatic brain injury. The evidence base for the assessment of non-progressive dysarthria remains limited with professional practices relying mainly on therapists’ clinical experience. Limited information on the assessment practices of Lebanese speech and language therapists (SLTs) is available. Such information is crucial for the development of adequate therapy services for clients with non-progressive dysarthria. This study aims to explore the assessment practices and attitudes of Lebanese SLTs working with adults with non-progressive dysarthria and to investigate their adherence to the framework of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF).MethodsA cross-sectional study was conducted in Lebanon between March and May 2021. Data was collected through an online survey that included information on socio-demographic characteristics, practices, and attitudes of SLTs who assess adults with non-progressive dysarthria.ResultsA total of 50 Lebanese SLTs responded to the survey. The majority of SLTs (78%) assessed clients with non-progressive dysarthria across all ICF domains. SLTs reported dissatisfaction with the available assessment tools (64%) and reliance on informal tools (84%). In addition, 68% of the SLTs suggested the crucial need for the development of Arabic formal assessments that can quantitatively evaluate dysarthria and determine severity. The survey also showed that the respondents demonstrated a preference for the use of impairment-based tools.ConclusionIt can be concluded that the assessment practices of Lebanese SLTs, generally, follow the international trend and the recommended professional guidelines. Further research initiatives should be held to develop Arabic formal assessment tools for non-progressive dysarthria.

This paper examines assessment report-writing from a critical perspective, a relatively unexplored aspect of speech and language therapy (SLT) clinical practice. To date, there has been little discussion of the relationship between discourse formats, objectives of assessment reports, and the effects of these objectives on how clients and speech and language therapists (SLTs) are portrayed. Furthermore, there has been little exploration of the concepts of objectivity and scientific writing in relation to report-writing in SLT. An emphasis on a scientific, objectifying system has long been in operation in the profession: the establishment of diagnostic categories and the relegation of the personal, subjective experiences of client and SLT to secondary, non-scientific status. However, person-centred care (PCC) is now a focus in SLT in an attempt to rehumanise care by considering clients as unique individuals with important knowledge to contribute. To examine representations of clients and SLTs in assessment report-writing drawing on systemic functional linguistics (SFL) and critical discourse analysis. A total of 28 assessment reports were collected: 18 assessment report-writing exemplars from published texts aimed at modelling professional report-writing and 10 assessment reports from clinical practice. The global structure of the reports was identified, and the reports were also analysed using transitivity analysis as defined in SFL. Doing, saying, sensing, and being processes, and passives were identified. Without exception, all reports followed a similar global structure for organising the content, with an overall focus on presenting the speech, language, communication, and swallowing/feeding impairments under consideration while omitting the perspectives of the clients and families.The global structure was characterised by a problem focus. The use of passive verbs masked the SLT as an agent of clinical actions and positioned the clients as recipients of the actions of unidentified professionals while also under-emphasising their individual perspectives, experiences, and goals. SLTs used categorical assertions (i.e., declarative statements with no modality) to make claims appear scientific, while the relatively less-frequent contributions of clients and family members were introduced using saying processes, highlighting their subjectivity. In the paediatric reports, no child's perspective was included. Findings reveal an almost exclusive focus on impairment combined with an absence of the client's perspectives, experiences, and goals. Consistent patterns were identified across the data sets. First, verb choices position clients as passive recipients of the actions of the SLT rather than agents in their own right. Second, markers of scientific discourse such as agentless passives remove both the SLT and the client as agents/actors in the SLT assessment process.The findings require us to consider the implications of perpetuating the status quo of report-writing featuring mainly deficit discourse and how we may incorporate PCC in SLT report-writing. What is already known on this subject A focus on the person in SLT has long been advocated in the literature. The medical model has long been critiqued, and a biopsychosocial model has been promoted.Person-centred care is being implemented in a range of settings globally. Report-writing practices in SLT have not been explored in relation to representations of clients and SLTs at a micro-level. What this study adds to existing knowledge This study provides an account of assessment report-writing practices in speech and language therapy (SLT). It highlights the discourses of deficit that permeate the reports through a predominance of patterns which obscure the SLT as an agent of clinical actions, position the client as a recipient of those actions, and omit the personal perspectives of clients and their families. The 'objective' is privileged over the subjective, the legal and systemic constraints of the report-writing contexts notwithstanding. What are the potential or actual clinical implications of this work? It can be claimed that in order to successfully argue for services, assessment reports must make a case for client incompetence. This study challenges this claim and provides clinicians with a critical perspective on assessment report-writing practices in SLT. The study also encourages SLTs to consider ways in which report writing may be made more person- and strengths-focused while simultaneously conforming with/to legal and professional requirements.

Aerosol generating procedures, dysphagia assessment and COVID-19: A rapid review.

Knowledge, experience and practice of SLTs regarding (re)habilitation in deaf children with cochlear implants