Clinical services for aphasia: A survey of university clinics

Abstract

Background: University speech and hearing clinics are an essential component of most graduate students' clinical training (ASHA, 1985). In addition, they provide comprehensive clinical services to a diverse clientele, including individuals with aphasia. University clinics may provide an important service-delivery option in the continuum of care for individuals with aphasia particularly in light of service-delivery challenges created by changes in health care reimbursement in the USA. Aims: The purpose of this survey research was to investigate the role of university speech and hearing clinics in the United States in the management of aphasia. A specific aim was to determine the nature of the aphasia clientele, reasons for referral, types of therapy programmes, and other issues related to the delivery of clinical services to individuals with aphasia in university speech and hearing clinics. Methods & Procedures: A 16-item survey was mailed to clinic directors of 241 university training programmes in the United States. The data were collected from autumn of 1997 through spring of 1998. Outcomes & Results: Responses were received from 133 programmes, representing a 55.2% response rate. Data are presented from 126 speech and hearing clinics in the USA that reported outpatient clinical services for people with aphasia. Survey results showed that the typical profile of a person referred for clinical service was someone with nonfluent aphasia in the moderate-to-severe range of impairment who was over 6 months post-onset of injury. Survey findings also indicated that many individuals with aphasia had exhausted their rehabilitation dollars at acute-level facilities and were subsequently referred to university clinics by a speech-language pathologist or a friend or family member. Almost half (48%) received clinical services for 1–2 years, and the majority of university clinics provided clinical services at a relatively low cost. Conclusions: University training programmes varied in their number and type of clinical services provided to people with aphasia. Overall, programmes with more diverse clinical services appeared to assess or treat a greater number of individuals with aphasia in their university clinics. In addition, many university programmes integrated clinical services within their communities through activities such as support groups. The results from this survey study suggested that university speech and hearing clinics are a legitimate component of the “continuum of care”, particularly for people with chronic aphasia.