The practices and perspectives of Australian SLPs who treat adolescent and adult stuttering: a preliminary study

Children with communication disorders experience difficulty in one or more areas of articulation and speech, language, fluency, voice and social communication, and they work with speech-language pathologists (SLPs) to improve their communication. With the rise of adoption and use for mobile applications among special education and healthcare service providers, SLPs also have implemented, and for some, contributed to the design of, mobile applications (apps) during clinical practice. However, how these mobile apps are designed and implemented for clinicians to facilitate their clients' communication and learning experiences during therapy remains underinvestigated. This qualitative research study investigates how mobile apps were designed for clinicians to target assessment and intervention goals. Additionally, it focused on how clinicians adopted these apps while integrating therapy techniques to facilitate their clients' learning. Informed by the Research, Practice, and Design for iPad Apps (iRPD) framework and the Consolidated Framework for Implementation Research (CFIR), semi-structured interviews were conducted with 37 licensed pediatric SLPs, including 23 SLPs who have used apps and 14 SLPs who have contributed to the design of their own mobile apps. Two rounds of qualitative coding via template analysis and thematic analysis were then used to analyse client and clinician characteristics, clinical practice, therapy tools, app characteristics, influential factors and app design and use recommendations. Results showed SLPs utilise different genres of assistive, educational and recreational game apps to support children's communication development when working with children who have diverse disorders and therapy needs across different age groups. SLPs who have designed their own apps emphasised the importance of following evidence-based practice, well-researched teaching methods and learning theories. Additionally, multiple financial, sociocultural, political and ethical factors contributed to the design, adoption and implementation of mobile apps during services. By understanding the clinician's app use practices situated in various therapy activities and techniques, we specified a list of design recommendations for app designers who are interested in creating mobile apps for supporting children's speech and language development. By bringing insights from both clinical practitioners as well as those with additional technical design backgrounds, this study contributes to the understanding of clinical practice needs and strategies and will lead to the most optimal app design and adoption practice to support the well-being of children with communication disorders. What is already known on the subject Speech language pathologist (SLPs) implement mobile apps for clients with diverse therapy needs, and their app adoption and use are influenced by multifaceted factors. Although prior studies have reported SLPs' mobile app use, additional information is still needed. For example, the research literature does not include how specific technology is used during therapy practice, or specific details about challenges and needs in implementing and utilising the technology. Additional research also needs to include influential factors (e.g., financial, sociocultural, political, ethical) that are considered when selecting, implementing, assessing and designing an app. The lack of research in these areas directly affects the understanding of clinical mobile technology practices and further hinders clinicians' abilities to advocate for better clinical and design decisions towards identifying and implementing effective mobile apps that facilitate children's communication. What this study adds to existing knowledge This qualitative study is the first known empirical research that interviewed pediatric speech-language pathologists who have used and designed mobile apps for children who receive speech-language therapy across different clinical settings. By investigating experiences from clinician stakeholders to illustrate a holistic overview of app design and development to deployment, this study reported finding on (1) how clinicians use mobile apps to help children to participate in different therapy activities, and (2) a list of recommended design and development guidelines that informs the design and use of mobile apps that best support and motivate children to engage in therapy. What are the potential or actual clinical implications of this work? This study disseminates clinician-reported practices of app design and use with pediatric clients across different speech-language disorders, and identifies gaps and needs for clinicians and researchers who are interested in understanding the role of mobile technology in relationship to human communication and interaction. Additionally, the paper demonstrates that SLPs have instrumental roles rather than passive users in influencing the design and implementation of different genres of mobile apps through evidence-based clinical practice, and call for partnerships across clinicians, special educators and technologists to support children's communication development.

Background: Evidence-based practice (EBP) was introduced to the profession of speech-language pathology in 2004. However, the limited empirical and implementation literature on EBP in speech-language pathology suggests that the field lags behind other healthcare disciplines, including physical therapy, occupational therapy, and nursing. Additionally, the limited empirical literature on EBP in speech-language pathology identified a need to know how speech-language pathologists (SLPs) in healthcare 1) defined and described their use of EBP and 2) perceived barriers and facilitators to utilizing EBP in clinical practice. While in the clinical instructor role, SLPs are expected to integrate theoretical, evidence-based knowledge in their clinical practice to facilitate novice clinicians' knowledge and skills in communication and swallowing disorders. The limited empirical literature on clinical supervision in healthcare settings identified a need to know how SLPs in healthcare 1) modeled and taught EBP in clinical supervision and 2) perceived barriers and facilitators to clinical supervision in healthcare settings Purpose: The purpose of this study was to describe the current use of EBP by SLPs in clinical practice and novice clinicians’ training in EBP by capturing the experiences of SLPs who have worked in clinical practice and as clinical instructors for the discipline in the healthcare setting. Method: In-depth individual semi-structured, open-ended interviews were administered to 15 experienced SLPs who have served as clinical instructors in the healthcare setting to understand their perspective of EBP in clinical practice. SLPs were asked questions regarding their description of EBP, their definition of EBP, and barriers and facilitators to EBP in clinical practice and supervision. Results: SLPs' definitions of EBP often focused on the scientific literature (external evidence) and did not include the three components of the EBP definition – clinician expertise, client perspectives, and the evidence (external and internal). SLPs reported using EBP to guide and validate their clinical decisions. SLPs identified graduate school, continuing education, independent learning activities, and the clinician/researching relationship as sources of information. Identified barriers to EBP were accessibility, lack of clinical application and generalization, limited use of data collection and data analysis by SLPs in clinical practice, lack of skills to interpret statistical methods, cost, time, and regulations. Reported facilitators of EBP were advocacy and promotion, clinical supervision, and facilitation strategies. SLPs’ also reported incorporating EBP into clinical supervision. Conclusion: SLPs’ definitions of EBP suggest they weighed research (external) evidence more than the other components of EBP. SLPs’ relied primarily on external evidence sources

STRUGGLING FIELD OF SPEECH-LANGUAGE PATHOLOGY IN PAKISTAN

Background: Despite the great need and significance for documentation of knowledge, attitudes, and practice of speech and language pathologists (SLPs) about evidence-based practice (EBP), few studies have been performed in this field among SLPs, especially Iranian SLPs. Objectives: The present study aimed at investigating the knowledge, attitude, and practice of Iranian SLPs toward EBP. Methods: This cross-sectional study was conducted from October to December 2019, in Iran. A valid and reliable self-administrated questionnaire (The Speech and Language Pathology Evidence-Based Practice questionnaire (SLP-EBPQ)) was used to evaluate the attitude, knowledge, and the use of evidence sections of SLP-EBPQ among 600 Iranian SLPs. Results: Four hundred twenty-two out of 600 questionnaires were returned. The mean figure of the knowledge score of the SLPs was 3.85 (± 2.8), while SLPs with postgraduate degrees scored higher in the knowledge section than those with an undergraduate degree (P < 0.001). The mean figure of the attitude score of the SLPs was 46.97 (± 4.55). Conclusions: The findings of the present study showed that SLPs in Iran have positive and favorable attitudes toward EBP with an effective application. Our findings also showed that EBP knowledge is not very comprehensive among SLPs; however, the postgraduate SLPs presented a higher EBP compared with the undergraduate SLPs.

Evidence-based speech therapy involves the integration of (1) the scientific evidence for therapy with (2) the perspectives of clinicians concerning therapy and (3) the perspectives of patients about therapy. The cleft literature has already paid attention to the first two cornerstones of evidence-based speech therapy. Much less is known about how children perceive cleft speech therapy. The purpose of the current qualitative study was to investigate the perceptions, emotions and expectations of Flemish-speaking Dutch children with a cleft (lip and) palate (CP ± L), aged 5-12 years, with regard to the speech therapy they receive. In this study, a focus was made on speech therapy to eliminate compensatory cleft speech errors. Six children with a CP ± L, aged between 5 and 12 years, were included in this study. Child-friendly semi-structured interviews were conducted using a participatory, art-based qualitative approach. This means that the 'play and puppets technique' and 'draw-write and photo-elicitation technique' were used to guide the children through the interviews. Data derived from these interviews were analysed using an inductive thematic approach. Trustworthiness of the data was achieved by applying researcher triangulation, negative case analysis and an audit trail. Analyses of the interviews revealed three major themes of importance to the children: (1) treatment values, (2) treatment practices and (3) treatment outcomes. Each theme was divided into different subthemes. The theme 'treatment values' consisted of the subthemes expectations and emotions around therapy and interference with daily living. Information flow, therapy content, confirmation and rewards, parents' attendance, therapy intensity, and homework were subthemes of the major theme 'treatment practices'. The theme 'treatment outcomes' was divided into two subthemes, namely speech improvement and peers' reactions. Most children had positive attitudes towards speech therapy: it was 'something they liked' and 'something fun'. If children had negative attitudes they were related to having a fear of making mistakes during therapy. Children had clear expectations of the purpose of speech therapy. Speech therapy should 'help' improve their speech and make it more understandable to others. The children in this sample made some suggestions to decrease the experienced burden related to speech therapy. The results of this study will help to better tailor speech therapy programmes to the needs and experiences of children with a CP ± L. What is already known on the subject Evidence-based speech therapy involves the integration of (1) the scientific evidence for therapy with (2) the perspectives of clinicians concerning therapy and (3) the perspectives of patients and their families about therapy. The cleft literature has already paid attention to the first two cornerstones of evidence-based speech therapy. Different studies investigated the perspectives of SLPs and parents with regard to cleft palate speech therapy. However, much less is known about the children's own experiences with and perceptions around this speech therapy. What this study adds to existing knowledge This study used a qualitative research design to investigate the perceptions, emotions and expectations of children with a cleft (lip and) palate, aged 5-12 years, with regard to the speech therapy they receive. Speech therapy needed to focus on the elimination of compensatory speech errors. This study provides knowledge on the speech therapy-related experiences of children with a cleft palate. What are the potential or actual clinical implications of this work? Children in this sample made some concrete suggestions to decrease the experienced burden related to cleft speech therapy, for example, integration of school work during therapy sessions and practising on the level of spontaneous speech. The results of this study help us to better tailor speech therapy programmes to the needs and experiences of children with a CP ± L.

Current research investigating collaboration between parents and speech and language therapists (SLTs) indicates that the SLT role is characterized by therapist-led practice. Co-working with parents of children with speech and language difficulties is less frequently described. In order to embrace co-working during intervention, the SLT role may need to be reframed, focusing on acquiring skills in the role of coach as well as the role of planning intervention and treating children. To report (1) SLTs' conceptions about their own roles during intervention for pre-school children with speech and language difficulties; and (2) SLTs' conceptions of parents' roles during intervention. A qualitative study used individual, semi-structured interviews with 12 SLTs working with pre-school children. Open-ended questions investigated SLTs' expectation of parents, experience of working with families, and the SLTs' conception of their roles during assessment, intervention and decision-making. Thematic network analysis was used to identify basic, organizational and global themes. SLTs had three conceptions about their own role during intervention: treating, planning and coaching. The roles of treating and planning were clearly formulated, but the conception of their role as coach was more implicit in their discourse. SLTs' conception of parents' roles focused on parents as implementers of activities and only occasionally as change agents. Collaboration that reflects co-working may necessitate changes in the conception about the role for both SLTs and parents. SLTs and parents may need to negotiate roles, with parents assuming learner and adaptor roles and SLTs adopting a coaching role to activate greater involvement of parents. Applying conceptual change theory offers new possibilities for understanding and enabling changes in SLTs' conception of roles, potentially initiating a deeper understanding of how to achieve co-working during speech and language intervention.

BackgroundPhonetic transcription is recognized in regulatory standards as an essential skill for Speech and Language Therapists (SLTs) in the assessment, diagnosis and management of clients with speech difficulties. Previous research has identified that approaches to phonetic transcription vary, and that SLTs often lack confidence in transcribing. However, SLTs’ views and working practices have not been investigated in detail, particularly in terms of whole service approaches and following the recent increase in telehealth.AimsTo investigate SLTs’ views about phonetic transcription, their working practices at both individual and service levels, and the factors that influence these.Methods & ProceduresA total of 19 SLTs from the UK were recruited to online focus groups via social media and local networks. Participants discussed their views of, and practices in, phonetic transcription. Themes were identified using reflexive thematic analysis.Outcomes & ResultsThree broad themes were generated division and unity; one small part of a big job; and fit for purpose. SLTs were uniformly proud of their ability to phonetically transcribe and viewed this as a unique skill, but clear differences existed between different groups of SLTs in their views and practices. Investing in phonetic transcription was not always a priority for SLTs or services, and although many felt under‐confident in their skills they considered these to be adequate for the populations they usually encounter. SLTs make an early judgement about possible therapy targets, which influences the level of detail used in their phonetic transcription. Practical barriers are often not addressed at service level, and assessment via telehealth poses some specific challenges.Conclusions & ImplicationsSLTs and services would benefit from increased investment in phonetic transcription in terms of time, opportunities for continuing professional development (CPD) and initiatives such as electronic patient records (EPRs) which support the use of phonetic symbols. Identifying target sounds at an early stage raises questions about the implications of disregarding other features of speech, and the selection of appropriate intervention approaches. Further research is needed to analyse actual rather than reported practices, and to consider the relationship between phonetic transcription and intervention approaches. Future studies could also identify precise CPD requirements and evaluate the effectiveness of CPD.What this paper addsWhat is already known on the subjectPrevious research has demonstrated that SLTs often lack confidence in phonetic transcription and that practices are varied, with relatively little use of narrow transcription. SLTs are interested in opportunities to maintain and develop transcription skills but do not often undertake CPD for transcription.What this paper adds to existing knowledgeBy using focus groups as a forum for discussions, this study provides a rich and detailed insight into SLTs’ views about clinical transcription and their working practices, with previously unreported details about the reasons for these practices in a clinical context and at a service‐wide level.What are the potential or actual clinical implications of this work?Transcription is often de‐prioritized in non‐specialist contexts, with practical barriers and a lack of clear and consistent protocols at a whole‐service level. There is an opportunity for service managers to address the systemic difficulties in using transcription effectively by raising the profile and value of transcription amongst clinicians, and promoting CPD opportunities, using the findings of this study as a rationale for funding this. Together, these recommendations have the potential to improve client outcomes through more accurate assessment and diagnosis, and hence more appropriate intervention.

Social Media: It’s Different for Professionals

Australian speech-language pathologists’ experiences and perceptions of working with children who stutter: A qualitative study

Functional Communication Disorders (FCDs) are one specific presentation of Functional Neurological Disorder (FND). FND is characterised by neurological symptoms, such as sensory and motor symptoms, which are not explained by neurological disease. Speech and language therapists (SLTs) have expertise in managing communication disorders, including FCDs, though is not known is what clinicians do in practice to treat and manage FCDs. To explore the clinical practices of SLTs who regularly manage FCDs in the UK, including the assessment and intervention approaches taken. An online survey was developed using Qualtrics software and piloted before dissemination. Participants were experienced SLTs working in the UK who managed at least three FCD referrals a year. The survey was developed with a mix of qualitative and quantitative questions. The survey was disseminated via social media and professional networks. There were 73 completed responses to the survey. Participants reported working with a range of FCDs clinically, with functional stuttering and articulation disorders seen most frequently. SLTs reported working with a wide range of multidisciplinary professionals when managing patients with FCDs, though lack of access to mental health professionals was raised as an issue. SLTs reported using a combination of formal and informal communication assessments. Interventions varied, with a wide range of psychological approaches informing treatment. Lack of specific training, evidence base and negative attitudes around functional neurological disorder (FND) were raised as ongoing issues. Therapists encountered a wide range of FCDs as part of their clinical practice, though there was a significant disparity in the service and interventions offered. SLTs feel their input can be effective, but lack the resources, training and evidence-based interventions to provide adequate care. What is already known on the subject FCDs are one manifestation of FND and can present as a wide range of communication disorders. SLTs encounter FCDs as part of clinical practice, but report feeling unsure and underprepared to manage these disorders. Consensus recommendations have provided some guidance on how to manage these disorders, though what was not known was what practising SLTs are doing in practice with FCD patients: what assessment, intervention and management strategies they use, and what they feel are the facilitators and barriers to effective management. What this study adds to the existing knowledge This is the first UK-wide survey of FCD SLT clinical practice. The survey found that SLTs are seeing a range of FCDs as part of their clinical practice. SLTs reported that they feel their input is effective, that they had confidence in their ability to provide assessment and intervention, and that SLT for FCDs should be routine. SLTs reported using a wide variety of approaches to assessment and intervention. Barriers to effective management included a lack of resources, training, negative staff attitudes towards FND, and lack of research and evidence-based interventions. What are the practical and clinical implications of this work? This survey has found that SLTs working across the UK are providing input for patients with FCDs, but frequently reported feeling isolated and lacking clinical peer support. This shows the potential for networking groups to support SLTs to learn and share resources. There is a training need for SLTs and other healthcare professionals to tackle pervasive negative attitudes towards FND. Common themes in intervention approaches were found, but there was variability in the specific approach taken. This requires further research to guide SLTs on the best evidence-based practice.

Background: Identifying and removing the barriers faced by speech and language pathologists (SLPs) for implementing evidence-based practice (EBP) can facilitate its administration among Iranian SLPs. Objectives: The present study was conducted to explore the barriers to implementing EBP among Iranian SLPs. Methods: A total of 14 SLPs were recruited using a purposive sampling technique. Semi-structured interviews were conducted for data collection. The interviews continued until data saturation was reached. Data were recorded and transcribed verbatim, and qualitative content analysis was used for data analysis. Results: Data analysis yielded three themes, including individual factors, organizational (workplace) factors, and extra organizational factors, and 13 subthemes. Conclusions: This study demonstrated that Iranian SLPs are faced with several barriers to using EBP in clinical practice, which may be related to both the SLPs themselves and their surroundings. These barriers should be considered by policymakers, administrators, teachers, and rehabilitation team members to facilitate the implementation of EBP by SLPs.

Purpose: To investigate speech-language pathologists' current perceptions, previous training experiences, resources, barriers, and training needs in terms of evidence-based practices (EBPs) in two Asian countries. Method: Their knowledge and attitudes about EBP were explored using an online questionnaire. A descriptive analysis was conducted with consideration of the effect of demographic variables on knowledge and attitudes about EBP. Result: Malaysian speech-language pathologists (n = 98) displayed more positive attitudes toward EBPs, with a significantly higher (t (143) = 5.91, p < .01) total mean score (Mean = 120.7, SD = 11) compared to the Japanese speech-language pathologists (n = 47, Mean = 107.8, SD = 13.5). Malaysian practitioners who were female, worked full-time, and worked in government settings reported higher motivation to develop EBP skills. Japanese practitioners who worked in private sectors reported higher EBPs training needs than those in government settings. In both countries, speech-language pathologists with higher education levels tended to express fewer perceived barriers towards EBP. Conclusion: Findings could help local governance and speech-language pathologist associations to understand the current practices and professional development needs of speech-language pathologists, leading to more effective training programs and educating employers and managers who can reinforce EBP among practitioners.

Stuttering can significantly impact an individual's quality of life and has the potential to affect social interactions, academic and career opportunities, and well-being. Speech-language pathologists (SLPs) play a crucial role in the treatment of stuttering across the lifespan. This systematic review aimed to describe (1) how competent SLPs perceive themselves to be in their management of stuttering and (2) the factors that influence SLPs' perceived competence in managing stuttering. A comprehensive search of eight electronic databases resulted in 13 studies that met the inclusion criteria. A narrative synthesis was completed on the extracted data. Competence was perceived to be lower in treatment than in assessment. Perceived competence was higher in SLPs who saw people who stutter more frequently and engaged in more continuing professional education in stuttering. Factors affecting SLPs' perceived competence also included: the level of support to implement treatment, knowledge of stuttering, formal education in stuttering, years of experience as an SLP, experiences with stuttering, familiarity with people who stutter, previous treatment outcomes and the perceived complexity of stuttering. The available data were primarily focused on participants working in paediatric populations. The review revealed diversity in perceived competence when managing stuttering, influenced by factors related to SLPs' professional and personal experiences, the practice context and available evidence, with notable variation in competence across different settings and regions. Further research is required across the lifespan to better understand the relationships between factors and to guide future interventions for competence. What is already known on the subject Research has identified gaps in SLPs' knowledge, clinical experience and confidence in treating stuttering. These studies highlighted SLPs' limited awareness of effective interventions, varying levels of perceived competence across different age groups, low preference for treating stuttering and difficulty applying clinical trial evidence. This study was needed to consolidate these findings and examine factors influencing SLPs' perceived competence in stuttering management. What this paper adds to the existing knowledge This review provides a synthesis of SLPs' perceptions of their competency in managing stuttering and identifies key factors influencing competency. It details perceived competence of stuttering treatment across the lifespan, in assessment and treatment. Additionally, it explores factors such as experience with stuttering, level of support, the practice context, familiarity with people who stutter, the perceived complexity of stuttering and previous treatment outcomes. These findings have implications for stuttering treatment and guiding professional development. What are the potential or actual clinical implications of this work? The findings of this review emphasise the importance of ongoing education and support for SLPs to enhance their clinical competence in stuttering management. Specifically, targeted professional development, supportive work environments and familiarity with people who stutter can positively impact SLPs' confidence and proficiency. The results reinforced the need for SLPs whose caseloads include stuttering to prioritise ongoing education in stuttering, seek support to implement treatment where needed and pursue opportunities to gain experience with people who stutter. These insights can inform the development of guidelines and training programmes to improve SLPs' competence and ultimately benefit people who stutter.

Objective: This preliminary study aims to determine whether Speech and Language Pathologists (SLPs) in Türkiye utilize evidence-based practices (EBP) and their attitudes toward EBP. The information sources SLPs use for clinical decision-making, and the relevant barriers they encounter are also among the objectives. Methods: With a descriptive design, this study includes 88 SLPs. A four-section survey containing 46 items was distrib uted online to the participants. Results: Participants showed a strong consensus (91.3%) regarding the importance of EBP in clinical settings. Those with postgraduate degrees demonstrated more positive attitudes toward EBP than those with only a BA, and overall attitudes were positively correlated with both exposure to and use of EBP (P &lt; .05). No significant difference was observed in the use of EBP resources between the 2 educational groups. The main barriers identified were quality and the quantity of research, and time constraints. Conclusion: SLPs in Türkiye highly value EBP despite challenges related to resources and time. Increasing opportunities for EBP exposure—through workplace training and internship experiences—and integrating more EBP-related course work into university curricula could further strengthen its implementation in the field. Cite this article as: Selvi Balo S, Balo E, Tunçer AM. Speech-language pathologists and evidence-based practice: navigating attitudes, exposure, and barriers. Arch Health Sci Res. 2025, 12, 0122, doi: 10.5152/ArcHealthSciRes.2025.25122.

Aphasia therapy works!