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JCPSLP
Volume 17, Number 1 2015
Journal of Clinical Practice in Speech-Language Pathology
highlighted that entry level education may not provide
enough support for SLPs, “although sometimes I am not
sure extra stuff at uni would have made a large difference,
I would still encounter issues at a service level as well”.
Another respondent also suggested, “Increased hands-on
exposure to working with interpreters and working with
CALD clients as component of SP degree studies”. Apart
from the materials identified above, respondents were
keen for specific improvements such as those already
found in alternative and augmentative communication
devices, an updated Bilingual Aphasia Test (McGill, 2014),
and electronically based resources (online databases and
i-pad applications). Many respondents called for increased
continuing PD and education for SLPs and students in the
following areas:
•
the effect of bilingualism on language
•
assessment and intervention strategies
•
working with interpreters
•
the impact of aphasia on LOTEs
•
communication strategies with CALD clients.
Knowledge resource materials, specifically, clear protocols
and guidelines for assessment were also requested.
Speech Pathology Association of Australia, workplace
departments, and SLPs combined with interpreters were
identified as possible developers of such materials. One
respondent suggested an “awareness drive by the Speech
Pathology Association of Australia and joining together with
cultural communities to advocate for action”.
Confidence and satisfaction
Thirty-one per cent of respondents reported feeling
very
unconfident
to
somewhat unconfident
when conducting
aphasia assessment, and 34% when conducting aphasia
therapy. Eleven per cent reported feeling
very unconfident
to
somewhat unconfident
with their ability to effectively
communicate in their clients’ LOTE, 38% with their ability to
improve language processing, 30% with their ability to
improve client performance in everyday functioning, and
28% with their ability to improve their clients’ quality of life.
Only 11% reported feeling either
very
or
somewhat
unconfident
in their ability to establish a positive therapeutic
relationship with the client and their family. Sixty-five per
cent reported feeling either
very unsatisfied
or
somewhat
unsatisfied
with the availability of time to plan, prepare and
provide services to CALD clients and 89.1% reported
feeling
very unsatisfied
or
somewhat unsatisfied
with the
materials available for assessment and intervention.
Discussion
This paper extends the small but growing body of research
in this area, offering an opportunity for SLPs to voice the
challenges encountered and their suggestions for
improvements in aphasia rehabilitation for CALD
populations. This paper offers an insight into the state of
knowledge, skills, and resources available to our profession
and the perceived adequacy of our university education
training programs. Additionally, information about how
confident and how satisfied Australian SLPs are with the
services they provide to CALD clients with aphasia is
provided. It appears little improvement has been made
since Roger, Code, and Sheard (2000) carried out a survey
of practices over a decade ago.
In our study, over half of the respondents reported having
less than adequate levels of knowledge of aphasia in
relation to non-English languages. In terms of assessment
knowledge and skills, a lack of assessment and intervention
material, and also concerns with the quality of the services
provided were major challenges. They reported having
limited access to, and availability of, culturally appropriate
assessment materials and resources, specific LOTE
materials for aphasia-specific consumer education and
information. Additionally, a number of respondents reported
having limited knowledge and skills in appropriate
processes for assessment and intervention, linguistic
structures of LOTEs (e.g. morphology, syntax), speaking
client LOTEs, and education of the concept of aphasia, and
rehabilitation to CALD clients. Respondents also
commented on the limited amount of research about
aphasia management for CALD clients.
Many respondents commented on specific concerns
about the delivery of their services. With regards to
assessment, these were:
•
limited opportunity for informal observations
•
problems with transferring use of English assessments
to LOTEs
•
subjective measurements
•
difficulties assessing higher level language and literacy tasks
•
difficulties determining a diagnosis, in relation to whether
the SLPs were able to confirm whether a perceived
error was due to aphasia or ESL, differentiating between
different LOTE and dialects, and determining pre-
aphasia communication levels.
Challenges in intervention included:
•
difficulty choosing/accessing appropriate topics/materials
•
difficulty accessing group therapy for LOTE
•
difficulty determining the target language
•
ongoing concerns for support and carry-over post discharge
•
difficulty educating clients about the value of speech-
language pathology.
Additionally, difficulties with building client rapport, the
clients’ lack of uptake of health care services, and a fear
of behaving in a disrespectful manner in terms of clients’
religion and culture were also reported.
When asked to list changes they felt would be most
beneficial, the availability of culturally and linguistically
appropriate assessment and intervention materials and
addressing the knowledge and skill base of the profession
were again identified as major themes in the participants’
responses. Respondents suggested addressing entry
level SLP education – specifically, in providing linguistics
studies and increased lecturer support. One respondent
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Frequency of
use
pre-morbidly
Client
preference
Family
member
Most intact
language
Interpreter
availability
Very rarely Rarely
Sometimes Frequently
Very frequently
Figure 5. Frequency which different factors impact on language
selection for assessment and intervention