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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




somewhat unconfident

when conducting

aphasia assessment, and 34% when conducting aphasia

therapy. Eleven per cent reported feeling

very unconfident


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





in their ability to establish a positive therapeutic

relationship with the client and their family. Sixty-five per

cent reported feeling either

very unsatisfied




with the availability of time to plan, prepare and

provide services to CALD clients and 89.1% reported


very unsatisfied


somewhat unsatisfied

with the

materials available for assessment and intervention.


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












Frequency of







Most intact




Very rarely Rarely

Sometimes Frequently

Very frequently

Figure 5. Frequency which different factors impact on language

selection for assessment and intervention