Language Therapy Services Research Articles

Evaluating an early social communication intervention for young children with Down syndrome (ASCEND): results from a feasibility randomised control trial

BackgroundThis paper reports the results from a feasibility trial of an early parent-delivered social communication intervention for young children with Down syndrome (‘ASCEND’). The intervention focuses on developing children’s early social communication skills, in particular responding to shared attention. The aim was to inform the feasibility of running a full-scale trial through National Health Service (NHS) Speech and Language Therapy (SaLT) services, to assess whether the intervention is effective in improving language skills before children with Down syndrome start school.MethodsThis was a two-arm feasibility randomised controlled trial (RCT), with 1:1 randomisation stratified by trial site, comparing the intervention plus standard NHS SaLT provision with standard NHS SaLT alone. We recruited 20 children with Down syndrome aged between 11 and 36 months through 3 NHS SaLT services, 19 of whom were randomised (10 — intervention group, 9 —control group). Pre- and post-intervention and 6-month follow-up assessments included language, social communication skills, adaptive behaviour, quality of life (parents and children), parental anxiety and depression. The intervention was parent delivered with parents having access to SaLT services and the research team during the intervention. Data were collected on recruitment and retention, standard care, treatment fidelity, acceptability of the intervention by the parents and speech and language therapists, feasibility of collecting health economic measures and suitability of the primary outcome measure.ResultsThe sample was sufficient for a feasibility study. The intervention (manual, support, materials) was positively received by the participating parents. Speech and language therapists also evaluated the acceptability of the intervention positively. Treatment fidelity which was measured by completion of weekly parent diaries and two adherence phone call was acceptable as 100% of the parent diaries were returned, over 90% of the parental diaries were completed correctly and 100% of adherence phone calls were completed. Retention was acceptable at 84% overall. The preliminary health economic data suggest that this intervention will be low cost. The sample size calculation suggests that 290 participants would need to be recruited, with 228 having a complete data set, for a full RCT.ConclusionBased on recruitment, retention and treatment fidelity, as well as the acceptability of the intervention to parents and speech and language therapists, a full-scale trial would be feasible in order to assess the effectiveness of the intervention.Trial registrationISRCTN13902755, registered on 25th August 2020, http://www.isrctn.com/ISRCTN13902755

Speech and language therapists’ perceptions of contextual factors associated with communicative participation in children with developmental language disorders

Children with developmental language disorders (DLDs) may experience barriers to communicative participation. Communicative participation is defined as ‘participation in life situations in which knowledge, information, ideas or feelings are exchanged’. Barriers experienced in communicative participation cannot be explained by language competence alone and are thought to be influenced by contextual factors. A better understanding of these factors will contribute to tailored speech and language therapy services for children with DLD. We conducted a focus group study with 13 speech and language therapists’ (SLTs) to explore their perspectives on contextual (environmental and personal) factors in early childhood that are associated with communicative participation in children with DLD. The personal factor of child well-being, and the environmental factors of familial support and SLT service provision were developed through thematic analysis. The potential mediating role of these factors on communicative participation implies that it is important to address contextual barriers and facilitators in speech and language therapy services.

Using telepractice for language sampling during COVID-19 pandemic: A scoping review.

Language sampling is a widely used means of language assessment; it is based on the collection and transcription of a child's language production in various communicative contexts. The need for social distancing due to the COVID-19 pandemic impacted language sampling and speech and language therapy services in general. The in-person assessment became extremely challenging leading to the immediate increased use of telepractice in speech and language therapy. This scoping review aimed to identify the use of telepractice for language sampling in speech and language therapy during the COVID-19 pandemic. A scoping review of existing literature was performed to collect evidence on using language sample collection via telepractice. A database search was conducted in PubMed, PsycINFO, Cochrane Library, Mendeley, Electronic, and grey bibliography in 2022. Articles were included if they met the inclusion criteria. The quality of each selected study was assessed using the modified critical appraisal skills program (CASP) checklist. Systematic searches identified 51 studies with six studies in total meeting the inclusion criteria. The results showed that telepractice was a necessary tool during the pandemic of COVID-19 to conduct language sampling in speech and language assessment. Speech and language therapists (SLTs) effectively collected language samples through telepractice during the COVID-19 pandemic. Although, to date, the literature on language sampling via telepractice is limited. The need for SLTs to rely on telepractice for language sampling warrants further investigation.

Profiling the Roles and Responsibilities of Professionals and Non-Professionals Providing Speech Language Services for Individuals with CLP in Resource-Limited Regions.

Fourteen Speech and Language Therapists/Pathologists (SLT/Ps) from 13 countries across 5 continents made up the International Confederation of Cleft Lip and Palate and Related Craniofacial Anomalies (ICCPCA) CLEFT 2022 Speech Taskforce. Following a group consensus activity led by an external facilitator using Lightning Design Thinking principles, "task-shifting" was identified as the topic for this Taskforce. Absence and scarcity of SLT/Ps in many parts of the world have led to non-SLT/Ps delivering speech and language therapy services to individuals with cleft lip +/- palate. This narrative is the first known attempt to develop a framework, describing the different types of providers and their scope of practice.

Elucidating managerial, staff and client perspectives on the Speech and Language Therapy service in Malta.

Speech and language therapy (SLT) services are fundamental for communication, academic and social development. Evidence shows that demand for services is increasing, and this can adversely affect the quality of care. There are limited published studies in relation to the demand and quality of speech and language services in Malta. To elucidate the perspectives of speech-language pathologists (SLPs), service managers and parents of clients about the impact of factors pertaining to human resource development (HRD), human resource management (HRM) and the environment on the quality of the children's SLT service in western Malta. Also, to outline the beneficial strategies or recommendations to improve the quality of the service provided. A mixed-method study was used. Quantitative data provided by the Speech and Language Center (SLC) were analysed to determine demand over time using descriptive statistics. Qualitative data from one-to-one interviews using a bespoke questionnaire with managers, SLPs and parents were transcribed and analysed. Common and distinct themes in relation to the quality of services were then formulated and evaluated. Quantitative results highlighted that clients were not receiving the required number of the therapeutic sessions. In total, nine themes in relation to the quality of the SLT service were identified by parents, SLPs and managers. The factors affecting the service quality were outlined and subdivided under three branches: HRD, HRM and the environment. All factors within these subgroups are expected to enhance the quality of the service provided if they are enhanced and improved upon. Additionally, the results showed that a discrepancy between the perceived and offered SLT services was felt from the managers' and SLPs' perspectives; however, this was not felt by parents. For parents, the main concern was the availability and frequency of the therapeutic sessions provided. Insights from SLPs, managers and parents of clients highlighted the barriers and enablers of quality of service in SLT services for children. These findings can be used to improve services in Malta and other countries with similar contexts, mainly by altering time management, reducing demands and improving availability. What is already known on the subject SLT is proven to enhance a child's communication skills. Increasing demands for therapy can affect the quality of the service provided, ultimately affecting the child's progress. There is a gap in the evidence base regarding the quality of speech and language services for children in Malta and the factors which affect the quality of the service. What this study adds to the existing knowledge This is the first study of its kind in Malta. It seeks to identify the quality of SLT services for children from three different perspectives: service managers, SLPs and parents. In addition, this study investigated what affects the quality of SLT services positively or negatively. Through this study, the impeding factors were divided into three domains; HRD factors, HRM factors and environmental factors. These domains were mentioned by all three groups of participants because they affected the service negatively or positively. The main negative aspects included bad time management, high demands, and reduced availabilities and accessibilities, whilst positive aspects included improved support, relationships and the environment. What are the practical and clinical implications of this work? This study suggests reducing the managerial and administrational demands on SLPs and improving session frequency would enhance the quality of service. In relation to the three domains, the HRD factors that would enhance the quality of service are: SLPs' and parental competencies, enhancing SLPs' positive characteristics, positive attitudes and cooperation from all personas; for HRM resources the factors important for quality are strategic and risk management, workforce and recruitment; and for the environmental factors the physical environment and resources are important as they affect the service depending on their condition, that is, improved resources result in improved service. Such alterations would reduce the SLPs' demotivation and burnout due to reduced responsibilities, whilst improving accessibility and availability, ultimately enhancing the quality of the service provided.

The validation of aphasia united best practice recommendations with people with aphasia and their caregivers in Vietnam: a nominal group technique study

ABSTRACT Background Speech and language therapy is a relatively new profession in Vietnam and to date, 79 individuals have graduated from Master and Bachelor programs. For the few therapists working with adult populations, clinical guidance tailored to the Vietnamese context is limited. The Aphasia United Best Practice Recommendations were developed to provide multi-national guidance for the management of post-stroke aphasia and have been translated into 29 languages, including Vietnamese. To date however, their applicability to low-middle income countries with emerging speech and language services such as Vietnam has not been explored. Aims To determine the relevance, comprehensibility, and comprehensiveness of the Aphasia United Best Practice Recommendations to people with aphasia and caregivers in Vietnam. Methods and Procedures People with aphasia and their caregivers participated in focus groups, utilising the nominal group technique. Participants were recruited from four hospitals in Ho Chi Minh City. Participants with aphasia were sampled for severity of aphasia, age, sex, time-post onset, geographic location, employment status, and relationship. Participants reviewed the recommendations, rated relevance and comprehensibility (clarity), and made suggestions for improvement. Participants assessed the comprehensiveness of the recommendations and additional items were generated and prioritised. Data were analysed using descriptive statistics and qualitative content analysis. Outcomes and Results People with aphasia (n = 11) and caregivers (n = 17) participated in one of nine focus groups. People with aphasia rated all recommendations as relevant. Levels of agreement varied for caregivers and fell < 85% for one recommendation only (Recommendation 4 – relating to the need for all people with aphasia to have some means of communication prior to discharge). Both participant groups suggested changes to content and wording to reflect the context and culture of Vietnam. Three common themes within the newly proposed recommendations were identified across both participants with aphasia and caregiver groups: (1) easier access to speech and language therapy services and information about aphasia, (2) the need for psychological and social support for people with aphasia and (3) the need for increased community awareness and supports for people with aphasia and their caregivers. Conclusions and Implications The Aphasia United Best Practice Recommendations were perceived to be relevant, however new recommendations reflecting the unique cultural, economic and healthcare environment of Vietnam were identified. Recommendations relating to access to services and community-based rehabilitation were prioritised, supporting the need for continued growth and advocacy for the speech and language therapy profession in Vietnam.

Telerehabilitation Services for Communication Disorders during Covid-19 in a Tertiary Care Set-up: a Descriptive Report

Speech and language therapy (SLT) services were suspended for a major part in the year 2020 due to COVID- 19 spread. Reinstating SLT services via alternate medium of Telerehabilitation (TR) was imperative to provide continued care for various disorders along with providing a support base for the caretakers during these difficult times. This paper presents a descriptive report of SLT services provided via TR in a tertiary care hospital for months of January till October 2021.

EXPLORING THE CONSISTENCY BETWEEN TEACHERS' AND PARENTS' RATINGS OF CHILDREN'S LANGUAGE SKILLS

Aim: The study investigated the correspondence between parent and teacher assessments of 3 to 6-year-old children's language skills using the Expressive and Receptive Language Scales from the Early Childhood Developmental Screening Toolkit – BAASIK (an acronym in Latvian). Material and methods: Ninety-five preschool teachers and 424 parents participated in an online survey assessing the expressive and receptive language skills of children aged 3 to 6 years. Results: Spearman's correlation analysis revealed statistically significant (p &lt; .001) moderate to strong correlations between the ratings of children’s language skills by parents and teachers. For the Receptive Language Scales, correlations ranged from rS = .43 to rS = .6, and for the Expressive Language Scales, from rS = .54 to rS = .64. Conclusions: The study confirmed that parents’ and teachers’ assessments of children’s expressive and receptive language skills are significantly correlated. The BAASIK Expressive and Receptive Language Scales used by both parents and teachers could be effective for early screening, potentially aiding in the prompt identification of language development issues and the subsequent referral to speech and language therapy services.

Let the records speak: an exploration of rehabilitation services offered in primary healthcare, Johannesburg metropolitan district

BackgroundPrimary healthcare in South Africa aims to transform the national health system by emphasising community-based care and preventive strategies. However, rehabilitation services, particularly for individuals with disabilities and chronic non-communicable diseases, are often overlooked in primary healthcare. This study aimed to investigate the provision of primary healthcare rehabilitation services in the Johannesburg Metropolitan District by exploring client sociodemographics and variations in services provided by rehabilitation professionals.MethodsA retrospective review of clinic rehabilitation records from 2011 to 2020 was conducted at nine provincially funded community health centres (CHCs) offering rehabilitation services. Stratified sampling facilitated record selection based on rehabilitation service type and year. A specifically designed data extraction tool captured demographics, disabilities, rehabilitation received, and referral sources. Descriptive analysis used means, standard deviations, and frequencies.ResultsThe findings show a diverse client population with a wide age range, with a significant proportion falling into the < 5 years and 30–49 years age groups. Neuromusculoskeletal and movement-related disabilities were most prevalent, affecting approximately two-thirds of clients. Referral sources were often undocumented, and inconsistent discharge information with no record of patient follow up, highlighted the need for improved documentation practices. Clinic visits were the primary service delivery mode, followed by limited home visits and outreach services. Occupational therapy and physiotherapy were the most used services. Speech and language therapy services were underused, and some CHCs lacked audiology services. There were variations in the number of individual and group sessions provided by the different rehabilitation services, and there were age- and disability-specific differences in service use.ConclusionThis study offers insights into rehabilitation service provision in the Johannesburg Metropolitan District and enhances our understanding of rehabilitation services in primary healthcare settings. It underscores the importance of a multidisciplinary rehabilitation team to address diverse rehabilitation needs, improving documentation and discharge practices, expanding service delivery models, and reducing disparities in service use. The findings inform strategies for optimising service delivery, workforce, resource allocation, and intersectoral collaboration to ultimately enhance the quality and accessibility of integrated rehabilitation services.

Rearing a child with a language disorder: parents experiences with speech and language therapy services in 10 countries

Rearing a child with a language disorder: parents experiences with speech and language therapy services in 10 countries

Speech and language therapy services for autistic children in Munster: An interpretative phenomenological analysis of parental experiences and expectations

BACKGROUND: From a medical perspective, autism is characterised by a dyad of impairments in social communication and interaction, and restricted, repetitive behaviours. However, the neurodiversity movement sees autism as a difference and not as a disability. Autistic individuals account for 1–2% of the population and many autistic children and their families access Speech &amp; Language Therapy (SLT). In Ireland, SLT is provided across primary care, childrens’ disability network teams, as part of the progressing disability services for children and young people, and private providers. However, little is known about parents’ experiences accessing SLT services for autistic children. METHODS: This study aimed to investigate the parental experiences of SLT services for autistic children in the province of Munster, Ireland. Interpretative Phenomenological Analysis was used as a methodological framework. Semi-structured online interviews were carried out with six participants to identify their experiences of receiving SLT services for their autistic children. Data analysis followed a structured process, starting with in-depth explorations of individual datasets before cross-case analysis of the whole sample. FINDINGS: Participants expressed a variety of experiences and expectations of SLT provision, which centred on three thematic journeys: 1) Parenting an autistic child, 2) Experiencing and navigating SLT services for autistic children and 3) Evolving expectations of SLT service changes. CONCLUSIONS: Findings provide insight into parents’ individual and shared experiences of SLT services for autistic children, which may enrich service providers’ understanding of parents’ perceptions of SLT services. Future research should focus on exploring the experiences of autistic individuals and Speech and Language Therapists providing services for autistic children.2

Impact of the initial COVID-19 response in the UK on speech and language therapy services: a nationwide survey of practice

PurposeGlobally “non-urgent” health care services were ceased in response to the 2020 outbreak of COVID-19, until 2021, when restrictions were lifted. In the UK, this included speech and language therapy services. The implications of COVID-19 restrictions have not been explored. This study aimed to examine the impact of the UK’s COVID-19 response on speech and language therapy services.Design/methodology/approachAn online survey of the practice of speech and language therapists (SLTs) in the UK was undertaken. This explored SLTs’ perceptions of the demand for their services at a time when COVID-19 restrictions had been lifted, compared with before the onset of the pandemic. The analysis was completed using descriptive statistics and content analysis.FindingsRespondents were mostly employed by the UK’s National Health Service (NHS) or the private sector. Many participants reported that demands on their service had increased compared with before the onset of the pandemic. The need to address the backlog of cases arising from shutdowns was the main reason for this. Contributing factors included staffing issues and redeployment. Service users were consequently waiting longer for NHS therapy. Private therapy providers reported increased demand, which they directly attributed to these NHS challenges.Originality/valueThis presents the only focused account of the impact of the national response to COVID-19 on speech and language therapy services in the UK. It has been identified that services continue to face significant challenges, which indicate a two-tier system is emerging. Healthcare system leaders must work with service managers and clinicians to create solutions and prevent the system from being overwhelmed.

'Communication is difficult': Speech, language and communication needs of people with young onset or rarer forms of non-language led dementia.

People with behavioural variant frontotemporal dementia, Lewy body dementia, posterior cortical atrophy and young onset Alzheimer's disease may experience language and communication difficulties. However, the role of speech and language interventions for people with these non-language led dementias has received little attention. This study aimed to explore the experiences and perspectives of people living with these conditions, and their families, regarding their language and communication difficulties and how speech and language therapy could address these needs. This study employed a qualitative design to explore the experiences of people living with or caring for somebody with behavioural variant frontotemporal dementia, Lewy body dementia, posterior cortical atrophy or young onset Alzheimer's disease, and to understand their opinions about speech and language therapy. Participants were recruited from a support service connected to a dementia clinic to attend one of five focus group meetings. Videorecorded focus groups and interviews were transcribed, and reflexive thematic analysis was used to analyse data from people affected by each type of dementia. A total of 25 participants were recruited to the study, with representation across the different forms of non-language led dementias. The four main themes identified were: (1) communication difficulties as a key difficulty, (2) loss and loneliness, (3) speech and language therapy, and (4) the role of the caregiver. Sixteen subthemes were also identified which highlighted individual issues across disease types. Although all the forms of dementia studied here are not considered to be language-led, people with these conditions and/or their care partners identified speech, language and communication as common challenges. These communication difficulties were reported to have a negative impact on their social participation and mental health and participants felt speech and language interventions could help. There is a need for research exploring speech and language interventions developed for and with people with non-language led dementias and their care partners, to ensure they meet the needs of the people they are designed for. What is already known on the subject People with primary progressive aphasia present with speech, language and communication difficulties, and several speech and language interventions have been developed to meet the needs of this population. However, people with non-language led dementias may also experience speech, language and communication difficulties, and little is known about interventions that may address these difficulties. What this paper adds to existing knowledge People living with or caring for somebody with behavioural variant frontotemporal dementia, Lewy body dementia, posterior cortical atrophy and young onset Alzheimer's disease report experiencing speech, language and communication difficulties that impact on the person with dementia's social participation and mood. Participants in this study also shared their opinions about how speech and language interventions could help, from the earliest stages of the disease. What are the potential or actual clinical implications of this work? Speech and language therapists need to address the individual speech, language and communication needs of people with dementias, even those that are not thought to be language-led. Current speech and language therapy service provision does not meet the needs of people with non-language led dementias and further research is required to develop interventions and services to meet these needs.

Parents’ Knowledge, Perception, and Attitudes Towards Speech and Language Therapy Services of Individuals with Cerebral Palsy: A Quantitative Analysis

This study examines the relationship between parental knowledge, perception, and attitudes toward speech and language therapy for children with cerebral palsy. The study adopted a descriptive research design of correlational type. Purposive sampling was used to identify fifty parents of individuals with cerebral palsy as respondents in the Ibadan metropolis, Nigeria. Self-structured questionnaires on parental knowledge, perception, and attitudes toward speech and language therapy were used for data collection from the respondents. The findings revealed that parents had moderate knowledge about speech and language therapy, with varying levels of perception and attitudes toward speech and language therapy. The study's limitations include the small sample size, sampling bias, self-reported data, and limited geographic scope. These limitations should be considered when interpreting the study's findings. Despite these constraints, this research provides valuable insights into the complexities of parental perspectives on speech and language therapy for children with cerebral palsy. It highlights the need for further exploration in this area. Future research should address these limitations to understand parental experiences and perspectives in diverse contexts comprehensively.

Fifteen years journey of a private speech &amp;amp; language therapy service in rural Ireland - navigating the needs of the local communities and expanding collaborations.

Private Kerry SLT clinic (KSLTC) was started in January 2007 in rural Ireland, at the time when out-patient services were limited. At that early stage, there was only one speech &amp; language therapist (SLT) in the KSLTC providing the service a few hours per week. The majority of referrals came from medical consultants. Over the years, by maintaining a flexible approach to local community needs, KSLTC expanded and gradually changed the focus of care. Currently, there are seven therapists providing the SLT service in collaboration with local charities, schools, primary care, disability and acute services. &#x0D; This presentation is for anyone interested in collaborative private and public care and this could contribute to the delivery of integrated care. &#x0D; We aim to present the evolution and the current delivery of a small private service, which is based on local collaborations and distributed leadership. &#x0D; We would like to discuss:&#x0D; -how KSLTC evolved in response to the key developments in the public system, such as the reconfiguration of disability services for children or introduction of integrated care services for older people. &#x0D; -what are the service priorities and how they align with the needs of the local communities.&#x0D; -what are the main challenges and opportunities to progress collaborations with external services / agencies.&#x0D; KSLTC has been engaging in local collaborations since the beginning. Initially, the service provided by the KSLTC was guided by the requests of the local consultants and therefore the focus was medical in nature. Over the years it became apparent that the biggest community needs are in the area of early intervention, disability and autism. KSLTC entered various collaborations to ensure the service provided privately is integrated with the public system and where possible the funding was sought to subsidise the session cost for the clients. One example of the above collaboration is working jointly with a group of parents of children with Down syndrome and a group of parents with autism to co-design the delivery of SLT service. As a result, the services provided are not only clinic based, but are also delivered in the local schools, day centres and in people’s homes. The service is being evaluated jointly with the group of parents’ representatives. &#x0D; There every-day practice in KSLTC is based on the culture of mutual trust and respect. To provide an efficient service, a flexible approach guided by the service users’ needs is paramount. The integration with the public systems brings multiple opportunities, but also challenges. We hope that our experiences can be valuable to other professionals interested in managing and delivering clinical services with limited resources, private and public collaboration of care, and distributed leadership. &#x0D;

“When you are a parent of an autistic child, the responsibility is put on you a lot” - Learning from parents’ experiences and expectations of speech and language therapy services for autistic children in Ireland.

Autism is a neurodevelopmental disorder, characterized by deficits in social communication and interaction, restricted interests, and repetitive behaviours. Historically framed within the medical model paradigm, there are increasing calls from the autistic community to reframe autism, using the social model paradigm and embracing neurodiversity. Autistic individuals account for 1-2% of the population and access a variety of services, such as Speech &amp; Language Therapy (SLT), which support autistic individuals' engagement in society. &#x0D; There is a disparity of SLT services available for autistic people in Ireland and parents’ perceptions of services have not been investigated before. We aimed to investigate the parental experiences and expectations of SLT services for autistic children and make recommendations for stakeholders of autism service provision. This presentation is relevant to anyone interested in researching service users’ / parental perceptions and how they can guide the provision of care.&#x0D; This research formed a part of a Master’s degree. It was developed by a team of researchers representing SLT and social care services. The initial idea originated from clinical practice, where parents often voiced their concerns and expectations of care. &#x0D; Interpretative Phenomenological Analysis was used as a methodological framework for this study. Participants were parents of autistic children living in the Munster province of Ireland, and they were not previously known to the research team. Individual, semi-structured interviews were carried out to identify participants’ understanding of how they made sense of their experiences. Data was analysed in depth at an individual level before group analysis took place. &#x0D; &#x0D; Five themes emerged during group analysis: &#x0D; 1) The journey of parenting an autistic child, &#x0D; 2) The journey of experiencing services for autistic children, &#x0D; 3) The journey of navigating SLT services, &#x0D; 4) The journey of evolving therapeutic relationships and desirable clinical qualities,&#x0D; 5) The journey of evolving parental expectations of changes to services for autistic children.&#x0D; Parents’ understanding of SLT services for autism was fraught with doubts about the public health system and the financial burden of accessing private services. Parents’ searches for services revealed significant wait times and barriers to access supports. Parents desired speech and language (SLTs) with clinical experience and understanding of parents’ roles in SLT. The need for reduced waiting periods for services and compassionate support for families of autistic children was also reported.&#x0D; Findings provide insight into parents’ evolving expectations and suggested changes for services for autistic children, which are important for autism service providers. Future research should focus on autistic individuals’ and SLTs experiences of SLT services for autism.

Barriers for Audiology, Speech, and Language Therapy Services to Cochlear Implant Recipients

Background: With the rise in cochlear implant use among children with hearing impairments, understanding the challenges in providing effective audiology, speech, and language therapy services is crucial. These services are vital for the successful integration of cochlear implant recipients into mainstream society, particularly in terms of language acquisition and social-educational outcomes. Objective: This study aimed to find out Barriers of audiology, speech, and language therapy services to cochlear implant. Methods: A cross-sectional survey design was employed, involving 74 participants selected through non-probability convenience sampling. The study utilized a structured questionnaire covering demographics, availability of audiology, speech, and language therapy services, and specific issues related to cochlear implant use. Data were analysed using the Statistical Package for the Social Sciences (SPSS) software, version 20.0. Results: Among participants, 58.1% were aged 25-35 years; 67.6% were female. Educational levels varied, with 33.8% holding graduate degrees. Key barriers identified included distance to services, cost, and scheduling difficulties. 66.2% agreed that health insurance was a significant challenge, and 52.7% faced difficulties due to the unavailability of nearby speech therapists. Conclusion: The study highlights the critical need for accessible and tailored speech and language therapy services for cochlear implant recipients, especially in rural areas. Addressing these barriers requires concerted efforts from healthcare providers, policymakers, and community leaders to enhance the rehabilitation outcomes for cochlear implant recipients.

UK paediatric speech and language therapists' perceptions on the use of telehealth in current and future clinical practice: An application of the APEASE criteria.

Telehealth for paediatric speech and language therapy became one of the most salient modes of service delivery during the COVID-19 pandemic. Evidence for speech and language therapy services via telehealth in comparison to face-to-face delivery demonstrates promising outcomes, and studies have begun to explore practitioner and client experiences. However, across the literature, many critical elements of services are overlooked, and there is a need to frame the evidence base within a theoretical model that can draw out practical implications that consider the range of factors having an impact on clinical implementation in real-world contexts. The APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) criteria offer such a model. The current study explored practising UK speech and language therapists' (SLTs) clinical experience of telehealth through the lens of the APEASE criteria and aimed to identify recommendations for future service provision from the practitioner perspective. An online survey structured using the APEASE criteria was developed in collaboration with the UK Royal College of Speech and Language Therapists. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using reflexive thematic analysis. Four hundred and thirty-eight qualified and practicing UK paediatric SLTs completed the survey. Telehealth was broadly acceptable and practicable to SLTs yet there remains some uncertainty about its efficacy and cost-effectiveness compared to face-to-face interventions and how equitable it is for different population groups. SLTs reported that effective implementation of telehealth services was dependent upon several contextual factors; affordability was a perceived barrier to clients having access to telehealth resources, intervention via telehealth was perceived as more acceptable than assessment, and whilst many SLTs welcomed aspects of telehealth, there were concerns about the physical and mental health consequences for practitioners. Six themes for the future development of telehealth in paediatric speech and language therapy were identified: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance. Outcomes highlight promising, concerning and uncertain aspects of telehealth in paediatric speech and language therapy. SLTs value a flexible and tailored approach to service delivery and recommend that effective leadership, clear communication, ongoing policy and guidance development, upskilling of users and careful evaluation of impact are required to ensure optimal implementation. The APEASE criteria offer a valuable opportunity to enhance and streamline practice and research to ensure sustainable implementation of telehealth in the paediatric speech and language therapy services of tomorrow. What is already known on this subject The COVID-19 pandemic led to the increased use of telehealth as a main mode of service delivery in paediatric speech and language therapy. Pre-COVID-19, evidence for the use of telehealth in this field included small-scale experimental studies that reported on children with particular disorders and explored telehealth outcomes in comparison to face-to-face delivery. The realities of at-scale clinical practice were not well-represented, and critical elements of service such as cost-effectiveness were often overlooked in the paediatric literature. Furthermore, despite emerging global evidence for temporary telehealth responses to the crisis in speech and language therapy, the long-term and future use of telehealth remains unclear. What this paper adds to existing knowledge The current study applied the lens of the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) criteria, which were used in this case to consider socioeconomic, ecological and cultural factors to capture an overarching understanding of the use of telehealth in paediatric speech and language therapy, and to inform the role of telehealth in future, longer-term and at-scale service development. Results indicated emerging trends in UK paediatric speech and language therapists' (SLTs') perceptions of telehealth and SLTs perceived a hybrid approach to service delivery, combining mostly face-to-face services with some telehealth, was likely to continue in the future. We identified six themes to guide the future development of telehealth in paediatric speech and language therapy services: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance. What are the potential or actual clinical implications of this work? UK SLTs believe that speech and language therapy services using telehealth should be reflective, tailored and flexible to meet the requirements and circumstances of the children, young people and families served, as well as the physical and emotional needs of practitioners. SLTs recommend that this service development is clearly communicated to all stakeholders and suggested that those using telehealth should be supported through appropriate training, and ongoing effectiveness should be monitored. Telehealth is here to stay and the APEASE criteria offer a unique opportunity to ensure sustainable models of service delivery; to support co-ordinated leadership at the local, national and international levels and the development of policy and clinical guidance.

Understanding capacity for implementing new interventions: A qualitative study of speech and language therapy services for children with speech sound disorder.

Many speech sound disorder (SSD) interventions with a long-term evidence base are 'new' to clinical practice, and the role of services in supporting or constraining capacity for practice change is underexplored. Innovations from implementation science may offer solutions to this research-practice gap but have not previously been applied to SSD. To explain variation in speech and language therapy service capacity to implement new SSD interventions. We conducted an intensive, case-based qualitative study with 42 speech and language therapists (SLTs) in three NHS services (n = 39) and private practice (n = 3) in Scotland. We explored therapists' diverse experiences of SSD practice change through individual interviews (n = 28) or self-generated paired (n = 2) or focus groups (n = 3). A theoretical framework (Normalization Process Theory) helped us understand how the service context contributed to the way therapists engaged with different practice changes. We identified six types ('cases') of practice change, two of which involved the new SSD interventions. We focus on these two cases ('Transforming' and 'Venturing') and use Normalization Process Theory's Cognitive participation construct to explain implementation (or not) of new SSD interventions in routine practice. Therapists were becoming aware of the new interventions through knowledge brokers, professional networks and an intervention database. In the Transforming case, new SSD interventions for selected children were becoming part of local routine practice. Transforming was the result of a favourable service structure, a sustained and supported 'push' that made implementation of the new interventions a service priority, and considerable collective time to think about doing it. 'Venturing' happened where the new SSD interventions were not a service priority. It involved individual or informal groups of therapists trying out or using one or more of the new interventions with selected children within the constraints of their service context. New, evidence-based SSD interventions may be challenging to implement in routine practice because they have in common a need for therapists who understand applied linguistics and can be flexible with service delivery. Appreciating what it really takes to do routine intervention differently is vital for managers and services who have to make decisions about priorities for implementation, along with realistic plans for resourcing and supporting it. What is already known on the subject Many SSD interventions have an evidence base but are not widely adopted into routine clinical practice. Addressing this is not just about individual therapists or education/training, as workplace pressures and service delivery models make it difficult to change practice. What this paper adds to the existing knowledge This paper applies innovations from implementation science to help explain how what is going on in services can support or constrain capacity for implementing evidence-based SSD interventions. What are the potential or actual clinical implications of this work? Service managers and therapists will have a clearer idea of the time and support they may realistically have to invest for new SSD interventions to be used routinely.

Patient experience of telehealth appointments in head and neck cancer services during the COVID-19 pandemic.

The COVID-19 pandemic resulted in rapid changes to head and neck cancer (HNC) services. Multidisciplinary team (MDT) face-to-face appointments were converted to telehealth appointments (telephone and video-call) to reduce the risk of COVID-19 transmission. The literature exploring HNC patient experience of these appointment types is limited. To explore patient experience of telehealth appointments at one UK centre during the COVID-19 pandemic, as well as the variables that may influence patient preference for virtual or face-to-face appointments. A survey-based study design was used, with closed questions and open text options to capture the views of the participants. Quantitative data were analysed using descriptive statistics. Open text data was used to add depth to the findings. A total of 23 participant surveys were returned. Six categories were identified: Usability; Information receiving & giving; Satisfaction; Emotions and comfort; Rapport; and Travel time and cost. Overall, participants gave positive responses to each category and indicated that telehealth appointments met their needs. Areas for clinical consideration are highlighted. Variables such as age, travel distance from hospital site, fear of COVID-19 and information technology (IT) access did not appear to influence patient preference for appointment type. Going forward, telehealth may be considered for use in combination with face-to-face appointments in the HNC pathway. Areas for further development include a 'telehealth screening tool' that may help to identify those patients most appropriate for these appointment types, or who require support to access them. What is already known on this subject The COVID-19 pandemic resulted in major disruption to HNC centres across the world. Services adapted to meet the needs of patients with many implementing telehealth into pathways. Studies exploring telehealth in speech and language therapy (SLT) services with the HNC population indicate positive results. It is clear telehealth has a role in modern healthcare and should not be viewed as a temporary solution to the pandemic. It is, however, recognized that embedding telehealth into pathways is not straightforward and requires ongoing review and evaluation, which includes patient and clinician perceptions. What this study adds to the existing knowledge The service evaluation gives insight into HNC patient experience of telehealth appointments for MDT clinics (led by SLT, dietician and clinical nurse specialist) during the COVID-19 pandemic. Overall, patients report a positive experience of telehealth in the HNC pathway and are willing to accept this platform into their healthcare. Areas for clinical consideration are highlighted. What are the actual and clinical implications of this work? This findings of this service evaluation can be used to support the co-design of HNC pathways which embed telehealth as an option for patients. Areas that were important to the participants are highlighted; this includes the timing of telehealth appointments in the pathway, the need to meet the MDT face to face and the positive benefit of cost savings. The authors suggest a telehealth appointment screening tool as an area for future development.