Graduate Student Clinicians Research Articles

Telepractice-delivered communication training for informal caregivers of people with aphasia: A pilot study

Purpose To establish proof of concept of a student-led, telepractice-delivered communication partner training towards enhancing communication between people with aphasia and their informal caregivers in everyday conversations. Method Two dyads were recruited, each consisting of a person with aphasia and their caregiver. A pre-training questionnaire was completed by caregivers, followed by a weekly communication training session delivered by graduate student clinicians via telepractice to each dyad over 12 weeks. The caregivers then completed a post-training questionnaire. Both questionnaires included 13 Likert-scale questions and one open-ended question requiring an extended response. Result Pre- to post-training improvements for both dyads were identified on two domains of the questionnaire: (a) frustrations of the caregiver and person with aphasia and (b) caregivers’ knowledge and confidence in using communication strategies. This quantitative data was supported by additional extended responses regarding informal caregivers’ current communication strategies when communicating with the person with aphasia. Conclusion Both informal caregivers reported integrating communication strategies learned as part of the training in their interactions with the person with aphasia and experiencing fewer communication breakdowns during the two weeks following the training. The pilot study offers proof of concept for incorporating telepractice-delivered caregiver communication training as part of aphasia rehabilitation.

An Interprofessional Graduate Student and Family Coaching Program in Naturalistic Communication Techniques.

Researchers implemented a short-term cascading coaching model focusing on naturalistic developmental behavioral intervention with three participant triads. Triads consisted of a graduate student clinician, a minimally verbal child with autism spectrum disorder, and the child's parent. Coaching and intervention occurred during an interprofessional summer clinic that included graduate student clinicians from special education and speech and hearing sciences departments. The efficacy of short-term instruction, researcher coaching for student clinicians, and student clinician coaching of parents was evaluated using a multiple baseline across participants' design. The dependent variables were student clinician's and parent's use of elicitation techniques (creating communication temptations, waiting, and prompting) and response techniques (naturally reinforcing children's communication and providing spoken language models). Following coaching, parents and student clinicians from all triads increased their use of elicitation and response techniques, with very large effect sizes across all variables. Visual analysis findings suggest individualized differences and variability across triads. Implications for graduate education and parent coaching programs are discussed.

Promoting Reciprocal Relationships with Flexibility, Coaching, and Teaching (PRRFCT Match): A Virtual Parent-Mediated Intervention Package for Young Children with Developmental Disabilities.

This study aimed to evaluate Promoting Reciprocal Relationships with Flexibility, Coaching, and Teaching (PRRFCT Match), a parent-mediated naturalistic developmental behavioral intervention package. An expansion from an earlier pilot study (see Kunze et al., 2021), PRRFCT Match incorporates virtual coaching between a novice coach and parent to implement evidence-based, applied behavior analytic (ABA) techniques during play to increase engagement and decrease unengaged behavior exhibited by their young child with developmental delays(26-50 months old). Ten parent-child dyads were matched with a coach in this concurrent multiple baseline design across participants. Simulating the clinical training level of a novice early interventionist, nine graduate student clinicians received training as coaches on PRRFCT Match implementation and weekly supervision by a research team member. All aspects of training and intervention were delivered virtually. A visual analysis of the data combined with Tau-U revealed a strong basic effect between clinician coaching and parent strategy use. For child participants, a visual analysis and Tau-U results suggest that most increased engagement and decreased their unengaged behavior during the intervention. High variability, overlap, and high engagement at baseline are discussed. This study shows promise for the PRRFCT Match intervention package. The ABA technologies mediated by parents during play increased child engagement and decreased unengagement for most participants.

The Acquisition of Static and Dynamic Intervention Skills by Graduate Speech-Language Pathology Students.

Speech-language pathology programs use simulated learning experiences (SLEs) to teach graduate student clinicians about fidelity to therapeutic interventions, including static skills (clinical actions that are delivered in a prespecified way regardless of the client's behavior) and dynamic skills (contingent responses formulated in response to a client's behavior). The purpose of this study was to explore student learning of static and dynamic skills throughout SLEs and live clinical practice. Thirty-three speech-language pathology graduate students participated in this study. Students were first trained to deliver an intervention before having their treatment fidelity measured at three time points: an initial SLE, actual clinical practice, and a final SLE. Treatment fidelity was first summarized using an overall accuracy score and then separated by static and dynamic skills. We hypothesized that (a) overall accuracy would increase from the initial simulation to treatment but remain steady from treatment to the final simulation and that (b) students would acquire dynamic skills more slowly than static skills. In line with our hypotheses, students' overall accuracy improved over time. Although accuracy for static skills was mostly established after the first simulation, dynamic skills remained less accurate, with a slower acquisition timeline. These results demonstrate that SLEs are efficacious in teaching students the clinical skills needed for actual clinical practice. Furthermore, we show that dynamic skills are more difficult for students to learn and implement than static skills, which suggests the need for greater attention to dynamic skill acquisition during clinical education.

The “I” in ICAPs: examining treatment intensity under the microscope

ABSTRACT Background Intensive Comprehensive Aphasia Programs (ICAPs) provide high doses of treatment over short periods. Treatment intensity in post-stroke aphasia rehabilitation and research is not well understood and is typically underspecified, including within ICAPs and modified Intensive Comprehensive Aphasia Programs (mICAPs), in which intensity is a fundamental design component. One recently developed model of treatment conceptualisation, the Multidimensional Dose Articulation Framework (MDAF), may offer a systematic, comprehensive, and granular method of characterising treatment intensity, though this framework has not yet been used to capture elements of intensity and dose during an ICAP or mICAP. Aims The purpose of this paper is to examine and describe increasingly specific details of treatment intensity for both an ICAP and mICAP delivered at the University of Montana (UMT). Methods & Procedures Fourteen participants with aphasia attended an 84-hour ICAP (n = 8) or a 24-hour mICAP (n = 6) delivered by graduate student clinicians at UMT. Ethics approval was obtained from the UMT IRB (#13-23). We examined intensity and dose using components of the MDAF including broad temporal parameters, and episode-specific length and intensity. Descriptive statistics were used to report group-level, participant-level, and treatment-level parameters. Outcomes & Results In this descriptive manuscript, we use a series of vignettes to report temporal parameters from the MDAF including treatment duration, days, sessions, and session density, and episode-level characteristics including episode length and episode intensity. Vignette one examines ICAP and mICAP planned versus actual temporal parameters. Vignette two describes episode-level detail across two evidence-based treatments administered during the ICAP. Vignette three details differences in delivery of a single treatment approach between two participants. In each vignette, we discuss the benefits and challenges of tracking treatment intensity with fine detail. Conclusions Comprehensive specification of dose and intensity parameters is essential to compare efficacious treatment programs and to understand variability in treatment response across individuals with aphasia. The MDAF is a promising tool, though detailed treatment intensity remains a challenging construct to measure, particularly at the level of the episode. Clinical researchers interested in dose and intensity and authors of evidence-based therapy approaches must continue to work to define and describe active ingredients within therapy approaches.

Clinical Supervision Postpandemic: Providing a Continuity of Care and Supervision Using Zoom in the University Clinic Setting

Purpose: The COVID-19 pandemic necessitated the shift to telepractice by university clinics. Supervision then occurred through Zoom or other videoconferencing platforms. Although clinics have returned to in-person services, the use of telepractice still continues as a preferred form of service delivery for many clients. However, providing both telepractice and in-person supervision in one university clinic can present many challenges. This article describes how one pro bono university clinic is resolving supervisor observation issues and space limitations by implementing a cohesive, low-cost Zoom observation system that is used with both in-person and telepractice clients. Method: The history of the previous observation system is provided along with the factors that necessitated the shift to the videoconferencing platform. The authors describe the configuration of the clinic rooms, the equipment needed to implement a similar observation system, and recommendations for getting started. This article also discusses the benefits and challenges of using the Zoom observation system for supervision with graduate student clinicians and their clients. Conclusion: The information is relevant to programs seeking to implement an effective low-cost observation system for training graduate students in a university clinic.

“I Wasn’t Just Sitting There”: Empowering Care Partners through the Aphasia-Friendly Reading Approach

ABSTRACT Background Sharing stories is a way that people make meaning out of life and connect with others socially. For couples in which one person has aphasia, the ability to have conversations and share stories may be disrupted. Many people with aphasia benefit from support in constructing and sharing stories with others. To share experiences with his wife, the spouse of a person with aphasia developed an intervention approach called Aphasia-Friendly Reading that supports oral storytelling and sharing stories with others. Aim The current study explored the experiences of care partners in a pilot study using the Aphasia-Friendly Reading approach. Methods & Procedures Three people with aphasia and their care partners participated in the Aphasia-Friendly Reading pilot study one hour per week for 9 to 14 weeks. Following the pilot program, each care partner was interviewed about their experience participating in the study. Interview data was analysed using reflexive thematic analysis. Outcome & Results Three major themes were identified: (1) Care partner empowerment, (2) Collaboration, and (3) Different therapy experience. Care partners expressed that they were “totally involved” in all stages of the intervention and that they highly valued being involved. Further, care partners reported specific ways that they started taking initiative in supporting their partner with aphasia outside of the sessions. Care partners described the project as collaborative, noting the role of all participants in story co-construction and mentioning how they both taught and learned from graduate student clinicians. The care partners reported that the project was distinctly different from their previous therapy experiences, noting that they appreciated the person-centeredness of the stories, the fun of working together in sessions, and the opportunity to share their stories with the aphasia group. Conclusion The results indicated that the care partners experienced benefits of being actively included in the Aphasia-Friendly Reading approach. The approach appears to be harmonious with core values of the Life Participation Approach to Aphasia and research on the value of considering aphasia to be a family issue rather than an individual issue.

Influence of noise on perception of different types of dysarthric speech

Disturbances in the central nervous system may lead to changes in the speech muscle system, which impact muscle strength, tone, and coordination as well as movement speed, resulting in different types of dysarthria, each impacting respiration, phonation, articulation, resonance, and prosody differentially. Bilateral upper motor neuron damage leads to spastic dysarthria, cerebellar damage ataxic dysarthria, and damage to basal ganglia hypokinetic dysarthria. In estimating the severity of speech impairment, and measuring speech intelligibility, both reading and spontaneous speech samples are routinely used by speech-language pathologists. However, noise levels in acute and rehabilitation hospitals often exceed the World Health Organization guidelines (Busch-Vishniac et al., 2005) which may impact the clinical outcomes. In this study, 100 graduate student clinicians in Speech-Language Pathology measured speech intelligibility and estimated the severity of speech impairment of speech samples produced by three types of dysarthric speakers: spastic, ataxic, and hypokinetic, in two different noise conditions (quiet, and hospital noise). The differential impact of noise on different types of dysarthria is examined, and its implication on clinical outcomes is discussed.

Graduate Student Clinicians in Health Care Professions as Stakeholders in Intensive Comprehensive Aphasia Program (ICAP) Implementation and Research

Purpose: This article characterizes graduate student clinicians' (GSCs') understanding of their roles as stakeholders in clinical implementation and research before participating in an intensive comprehensive aphasia program (ICAP). Method: Seven GSCs participated in a pre-ICAP intervention focus group to characterize their perceived roles in stakeholder-engaged research. Following an extensive ICAP training orientation and clarification of key definitions, the focus group prompt asked GSCs to describe what they view as important issues for developing future research protocols that investigate student clinician outcomes in the context of an ICAP. Qualitative content analysis using an inductive coding approach was applied to the focus group transcript. Results: The GSCs preparing to participate in ICAPs report that they are highly invested in the clinical implementation and research of the ICAP service delivery model. Discussion/Conclusions: The GSCs are crucial stakeholders in the development of GSC-run ICAPs across clinical implementation and all phases of research.

Improving the Clinician-Client Relationship in Children’s Speech-Language Treatment: An Exploratory Online Training Study

Introduction: Clinician-client relationships impact treatment outcomes in speech-language pathology. Training clinicians to improve these relationships might therefore improve treatment outcomes but has not been examined in the field. This study is a preliminary investigation of whether training student clinicians can enhance clinician-client relationships in children’s speech-language treatment. Methods: The study followed a single-subject multiple baseline design. Five graduate student clinicians completed a web-based training on clinician-client relationships, which was implemented as a series of three modules discussing goals, tasks, and bond. The training’s impact on the student’s relationships with their child clients was examined through weekly ratings completed by the students, their supervisor, and some parents and children. Intervention effects were measured by visual analysis of baseline versus intervention phases and by Tau-U effect sizes. Results: Visual analyses supported change in just under half the possible opportunities, but improvements in the relationship were also present in many of the baseline phases. Tau-U effects that corrected for baseline trend reached significance in 18 of 29 instances, providing support for the effects of the intervention. Conclusions: This study provides initial evidence that clinician-client relationship training can be effective for speech-language pathology graduate students. Clinician-client relationship training is a promising area for future investigation.

Patient Perspectives of a University-Based Intensive Comprehensive Aphasia Program for Stroke Survivors with Aphasia

ABSTRACT Background Stroke survivors with aphasia who participate in intensive post-acute aphasia rehabilitation programs make a variety of significant investments. As the number of Intensive Comprehensive Aphasia Programs (ICAPs) increase across healthcare settings worldwide, patient perspectives of this innovative service delivery become increasingly important. Stakeholder perspectives can provide meaningful contributions to intervention implementation, growth, and sustainability. Aims The purpose of this pilot study was to qualitatively explore patient perspectives about the experience of participating in a university-based ICAP implemented by graduate student clinicians. Methods & Procedures Researchers used an interpretive phenomenological approach to analyze nine structured interviews from five stroke survivors with aphasia who described their lived experiences during an ICAP. Thematic analysis involved an iterative and collaborative coding process. Transcripts were coded and themes were developed from the patients’ shared perspectives. Trustworthiness was maximized through acknowledgement of the researchers’ positionality and bias, variation in the sample, member checks, and sustained relationships between stakeholders. Outcomes & Results Three primary themes emerged from patient interviews: (1) the ICAP is hard work; (2) the impact of the ICAP on communication is noticeable, and (3) relationships “make” the ICAP. Conclusions Themes support emerging evidence that ICAPs implemented by graduate student clinicians may be a worthwhile investment for many stroke survivors with aphasia, thereby contributing to the cost-benefit utility and implementation feasibility of this service delivery model. Stroke survivors with aphasia reported mixed levels of acceptability pertaining to the perceptible impact on communication improvement, and the challenging, rewarding, frequent, and varied opportunities to interact with others.

Student Clinicians' Views of Telepractice and In-Person Service Delivery

Purpose: The purpose of this study was to compare graduate student clinicians' self-reported perceptions of in-person versus telepractice service delivery based on preparation/training, treatment process, client and clinician engagement, data collection, and client progress. Method: This study used mixed methodology to answer three research questions: (a) What are the differences between students clinicians' perceptions pre– and post–in-person and telepractice service delivery, (b) What are the differences between student clinicians' views of in-person and telepractice service delivery, and (c) How do changes in the pre- and post-surveys represent the student clinicians' views of in-person versus telepractice service delivery? Graduate students completed pre- and post-surveys and participated in focus groups following 16 weeks of telepractice or in-person service delivery. Results: Overall, findings revealed more similarities than differences between telepractice and in-person service delivery based on students' self-report before and after treatment. Similarities included preparation methods, use of evidence-based practice, amount of family involvement, and client progress. Differences included amount of time to prepare for the session, establishing rapport, and collecting data. In the end, participants' self-efficacy and implementation readiness increased for both service delivery models. Conclusion: Findings from this study provide a foundation for graduate training by relating telepractice to in-person service delivery models. Supplemental Material: https://doi.org/10.23641/asha.21498636

Training School Professionals in a Global Pandemic: Insights From Elementary Education and Speech-Language Pathology.

The purpose of this research was to explore the preparation of practitioners from two disciplines-speech-language pathology and elementary education-who often work together in a school setting to identify ways to best support future professionals in their educational practicum settings. The primary research questions guiding this investigation were as follows: Did the student teaching and supervision experiences of preservice K-6 teachers (PSTs) and their mentors and speech-language pathology graduate student clinicians and their supervisors differ during the COVID-19 pandemic, and if so, in what ways? A total of 54 participants from one university participated in this study from four groups: 15 graduate student clinicians in a speech-language pathology program, 14 speech-language pathology supervisors, 14 PSTs, and 11 teacher mentors. Survey questions were designed to capture the perceptions of students and supervisors in the fields of speech-language pathology and elementary education who were in the school setting during the fall 2020 semester. Quantitative and qualitative questions were included to obtain information related to the following areas: planning, environment, supervision preferences, team experiences, professional development, and telepractice. Speech-language pathologists and teacher mentors reported being able to successfully mentor and supervise students in the school setting despite significant challenges presented by the global pandemic. Findings also identified several significant differences in the experiences of PSTs and speech-language pathology graduate student clinicians who were in the schools for field experiences. Overall, speech-language pathology graduate student clinicians and their supervisors as well as PSTs and their teacher mentors reported adequately navigating their field experiences during the COVID-19 pandemic. Implications for how these findings can inform professional preparation programs to optimize future educational and therapy outcomes for students are discussed.

Graduate Student Clinicians' Perceptions of Child Speech Sound Errors.

Speech-language pathologists (SLPs) rely on auditory perception to form judgments on child speech. This can be challenging for graduate student clinicians with limited clinical experience as they often need to judge children's speech errors using their auditory perception. This study examined how consistently graduate student clinicians used a 3-point perceptual rating scale to judge child speech. Twenty-four graduate student clinicians rated single words produced by children with typically developing speech and language skills and children with speech sound disorders. All participants rated the productions using a 3-point scale, where "2" was an accurate production, "1" was a close approximation, and "0" was an inaccurate production. Ratings were solely based on the auditory signal. These ratings were compared to a consensus rating formed by two experienced SLPs. Graduate student clinicians reached substantial agreement with the expert SLP rating. They reached the highest percentage agreement when rating accurate productions, and the lowest agreement when rating inaccurate productions. Graduate student clinicians reached substantial agreement with expert SLP rating in judging child speech using a 3-point scale when provided with detailed descriptions of each rating category. These results are consistent with previous findings on the role that clinical experience plays in speech error perception tasks and highlight the need for additional listening training in speech-language pathology graduate programs.

Online Training Modules for Teaching Assessment Skills to Graduate Student Clinicians.

Assessment is a crucial skill for speech-language pathologists, who rely on standardized tests to identify characteristics of speech, language, hearing, literacy, and related skill sets. Training in assessment administration is an integral part of graduate education that lays the foundation for appropriate use of these tools. Teaching students to administer standardized assessments is time intensive, can vary depending on student learning pace, and involves both general and test-specific knowledge. The current pilot study investigated the effectiveness of researcher-developed and scalable online training modules for beginning and advanced graduate students for knowledge and self-efficacy outcomes. Graduate students (n = 61) across four cohorts (two beginning and two advanced) were trained using online, asynchronous assessment training modules. The modules addressed the administration of standardized assessments using written tutorials, video demonstrations, and quizzes. Students completed pre- and posttests on knowledge and self-efficacy for administering and scoring the trained assessments before and after the online training modules. We found significant pretest to posttest gains in specific assessment-related knowledge for beginning and advanced groups. Following completion of the training modules, beginning graduate students demonstrated increased self-efficacy for general assessment principles, whereas advanced graduate students started and remained high in self-efficacy at posttest. Using researcher-developed online training modules, both beginning and advanced graduate students improved knowledge for assessment skills. These training modules can be used as a model for developing teaching materials across a range of assessments and related topics that are scalable in the context of remote teaching and learning.

A Survey of Speech-Language Pathology Graduate Students' Perceptions of Telepractice Pre- and Posttraining During the COVID-19 Pandemic

Purpose: Many university programs in speech-language pathology that offer clinical training as part of their graduate training transitioned to a telepractice service delivery model in response to the COVID-19 pandemic. The purpose of this study was to survey speech-language pathology graduate student clinicians on their knowledge of and comfortability with telepractice before and after participation in a telepractice training program. Method: Graduate students in a speech-language pathology distance program participated in a remote summer clinical internship that included a 5-week telepractice training. Pre- and posttraining surveys were completed by 27 graduate students. Results: Results of a Wilcoxon signed-ranks test indicated that posttest telepractice knowledge question scores were significantly greater than pretest telepractice knowledge question scores. Likewise, posttest telepractice comfort question scores were significantly greater than pretest telepractice comfort question scores. Conclusions: These findings support the need to integrate a telepractice component to clinical education for speech-language pathology programs at the graduate level. Offering a specifically designed and hands-on telepractice training to graduate students in speech-language pathology can be an effective pedagogical piece to university degree programs.

“We all have coping and communication problems”. Experiences of stroke survivors living with aphasia and graduate student clinicians who participated in a telehealth interprofessional psychoeducation and wellness group

ABSTRACT Background Aphasia negatively impacts functional daily communicative participation, participation in life’s domestic, educational, vocational and recreational roles, psychosocial well-being and social relationships, and overall quality of life, thereby increasing the need for holistic, comprehensive care. Interprofessional collaboration has the potential to increase comprehensive patient care while also improving education and training for student clinical providers. The Intensive Comprehensive Aphasia Program (ICAP) is a growing service delivery model that infuses comprehensive care and principles of neuroplasticity, making it an ideal context for interprofessional collaboration. Aims The purpose of this pilot project was to explore the perspectives of stroke survivors living with aphasia and interprofessional graduate student clinical providers who participated in a telehealth interprofessional psychoeducation and wellness group that was developed by healthcare providers from speech–language pathology and counseling to support aphasia recovery and living well with aphasia. Methods A qualitative phenomenological research design was applied to explore the experiences of five stroke survivors living with aphasia, one graduate student clinical provider from speech-language pathology, and one graduate student clinical provider from counseling who participated in an Interprofessional Aphasia Community Group, that took place during the Summer 2020 University of Montana Telehealth ICAP. Content analysis procedures were applied to verbatim transcripts obtained during weekly focus groups with the stroke survivors living with aphasia and student clinical provider reflections. Results Themes that emerged from weekly focus group transcripts suggest that stroke survivors with aphasia wanted less information during each group session, further simplification of information presented during the group sessions, and increased opportunities for discussion, communication practice, and time to connect with one another. Themes that emerged from graduate student reflections suggest that graduate student clinical providers were positively impacted by the interprofessional collaboration, improving skills, knowledge, and attitudes of their own and each other’s disciplines. These themes also identified methods for improving future interprofessional collaboration in the context of an ICAP. Conclusions This project documents what is believed to be the first telehealth delivered Interprofessional Aphasia Community Group in the context of an ICAP. Qualitative exploration of this interprofessional collaboration highlights the perspectives, voices, and experiences of stroke survivors with aphasia and graduate student clinical providers. These experiences offer insight into how collaborative care can increasingly improve participant experiences in the context of an ICAP.

Speech-Language Pathology Graduate Student Clinicians’ Self-Perceived Competency in Dysphagia Management

Speech-language pathologists (SLPs) are the preferred healthcare providers for managing the direct clinical care of patients with dysphagia. By assessing self-perceived competency during academic training, SLP graduate student clinicians may increase their understanding of their skills in dysphagia management. We modified the Dysphagia Competency Verification Tool (DCVT) to use a 5-point ordinal scale to explore how SLP graduate student clinicians’ self-perception of competency in dysphagia management changes over time and to determine the impact of clinical practicum experiences. Seventy-two SLP graduate student clinicians rated their self-perceived competency for four DCVT domains. We used Generalized Estimating Equations (GEE) models to analyze the statistical significance of self-perception of competency ratings for each of the DCVT domains across semesters while accounting for clinical practicum experiences. Overall, the SLP graduate student clinicians indicated an increase in DCVT scores from the beginning of their graduate training program to the time of graduation, but did not perceive themselves as Adequate on most items of the DCVT until their last semester. These results suggest that both SLP graduate student clinicians and SLP graduate training programs would benefit from using a standardized metric to assess self-perceived competence in dysphagia management. DCVT self-perceived competency ratings could inform SLP graduate student clinicians about areas of dysphagia management practice and skills that need further development, allowing them to target these specific areas and gain actual competence.

Engagement in small group interactions involving persons with primary progressive aphasia

Purpose: In group therapy, participant engagement is integral for achieving effective and meaningful interactions. Engagement is necessary not only for ensuring participation in the group, but also for promoting overall life engagement. Although engagement is vital to group therapy, it has remained largely unstudied, particularly in treatment for persons with primary progressive aphasia. Methods: Using samples from a videotaped small group interaction involving two graduate student clinicians and two persons with primary progressive aphasia, conversational actions contributing to engagement were identified and analyzed via content analysis and principles of conversation analysis. Results: Conversational actions resulting in engagement included clinician-appointed turns, participant affirmation, and member support. These conversational actions were found to maintain and/or increase wavering levels of participant engagement. Discussion: Findings for the study yielded clinical applications for clinician promotion of engagement during small group interactions involving persons with primary progressive aphasia to increase participant involvement and maximize therapeutic outcomes.

Speech Therapy Telepractice Services in Fiji: A Multicultural Experience for Graduate Student Clinicians

Purpose: The University of Maine Speech Therapy Telepractice Program provides speech therapy telepractice services to children with communication disorders at the International School Suva (ISS), Fiji. This partnership has fostered international engagement and multicultural experiences for graduate student clinicians in the Department of Communication Sciences and Disorders while filling a need for speech therapy services in Fiji. Despite infrastructure, scheduling, and COVID-19 issues, the benefits of this partnership have far outweighed the challenges. Clinical observations of the ISS children's responses have revealed excellent progress toward achieving therapy goals. Parents and school personnel have also reported a high degree of satisfaction with our services. The program has encouraged our graduate students to be resilient, out-of-the-box thinkers as they research a variety of multicultural issues and apply this new knowledge to the clinical programs of their clients. Conclusions: This article highlights the partnership between The University of Maine, Speech Therapy Telepractice Training Program and the ISS, Fiji, as an example for other academic programs that are interested in establishing international telepractice partnerships. A description of the telepractice clinical procedures and technology for service provision at the ISS is included, along with a discussion of the challenges and benefits for providing international speech therapy telepractice services. Two case examples illustrate the complexity of providing services to multilingual children with different cultural backgrounds.