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Diversity in practice



Volume 17, Number 1 2015

Journal of Clinical Practice in Speech-Language Pathology












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.


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