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Diversity in practice
20
JCPSLP
Volume 17, Number 1 2015
Journal of Clinical Practice in Speech-Language Pathology
KEYWORDS
APHASIA
CALD
CURRENT
PRACTICE
REHABILITATION
SURVEY
THIS ARTICLE
HAS BEEN
PEER-
REVIEWED
Sonia Pang
(top), Zaneta
Mok (centre) and
Miranda Rose
diverse (CALD) populations through the Speech Pathology
Association of Australia (2009) position paper
Working in a
Culturally and Linguistically Diverse Society
.
In Australia, much of the university curriculum and
research literature surrounding speech-language pathology
is tailored for monolingual English-speaking clients (The
Speech Pathology Association of Australia, 2009). This
has been identified as a challenge in scholarly discussions
on aphasia management for CALD populations (Kiran &
Goral, 2012; Lorenzen & Murray, 2008; Rose, Ferguson,
Power, Togher & Worrall, 2014). It has been suggested
that SLPs are required to make clinical decisions for CALD
clients with little support from the research literature and
evidence-based assessment and intervention materials
(Lorenzen & Murray, 2009; Roberts, 1998). The lack of
cultural and language concordance may translate into
health care disparities, as recently identified in post-stroke
speech-language pathology services (Mok, Rose, & Pang,
2013). However, little has been heard from the actual voices
of SLPs in Australia with regards to their own experiences
and practices. A comprehensive evaluation of our services
to CALD populations must include an investigation of the
current state of practice and also the state of knowledge,
skills, and resources available for such practice, as reported
by clinicians themselves.
Reported clinical practices of SLPs
working with CALD populations
Surveys by Roger, Code and Sheard (2000) and Al-amawi
(2012) have examined aphasia assessment practices with
CALD populations within Australia. Both studies found that
SLPs were requesting the development of more appropriate
assessment tools, and were reporting a lack of knowledge,
skills, and experience for working with clients from CALD
backgrounds. In an investigation into aphasia rehabilitation
practices of SLPs in Australia, Rose et al. (2014) found over
half of respondents rated their knowledge of, and
confidence with, therapy approaches and techniques for
CALD clients as less than adequate.
Elsewhere, similar findings have been reported by
Centeno (2009) who surveyed SLPs working in adult
neurorehabilitation in New York state, USA. Specifically,
respondents identified several important conceptual and
clinical areas which they felt to be important in entry-level
course training and continuing professional development,
such as the understanding of aphasia in bilingual speakers
and strategies for assessing and testing bilingual speakers.
This study investigated aphasia rehabilitation
practices for culturally and linguistically
diverse (CALD) populations via a national
survey of speech-language pathologists
(SLPs) in Australia. It also investigated the
perceived levels of knowledge, skills,
education, confidence, and satisfaction of
these SLPs when working with CALD
populations. Respondents (n = 73) reported
having limited knowledge, skills, education,
confidence, and satisfaction levels when it
came to providing aphasia assessment and
intervention for CALD populations. Reported
challenges and areas for improvement
included the limited availability of CALD
assessment and intervention materials, and
the limitations in clinical guidelines and
information about assessment and
intervention procedures. Such issues were
reported over a decade ago, yet our findings
suggest limited improvement. Increased
attention from universities, SLP departments,
and peak bodies is urgently required – and
suggested by SLPs themselves – if the quality
of service provision for CALD populations in
aphasia rehabilitation is to improve, and
disparities between CALD and non-CALD
services are to be addressed.
Introduction
As of 2011, 17% of people in Australia aged 65 and over
preferred to speak a language other than English (LOTE) at
home and 26% were born overseas (Australian Bureau of
Statistics, 2012). These statistics are likely to be reflected in
the caseloads of speech-language pathologists (SLPs) such
as in aphasia rehabilitation. Aphasia occurs in 30% of
people with first-ever strokes (Engelter et al., 2006). In
2012, 50,000 Australians experienced a stroke and over
420,000 people were already living with stroke (Deloitte
Access Economics, 2012). SLPs are reminded to monitor
the quality of their services to culturally and linguistically
Time for change
Results of a national survey of SLP practice in CALD
aphasia rehabilitation
Sonia Pang, Zaneta Mok and Miranda Rose