JCPSLP Vol 19 No 1 2017

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Communication and connection: Valuing Aboriginal and Torres Strait Islander perspectives
JCPSLP Volume 19, Number 1 2017 19
KEYWORDS
ABORIGINAL
ATTENDANCE
ENGAGEMENT
INDIGENOUS
SPEECH-
LANGUAGE
PATHOLOGY
studies have investigated Aboriginal families’ experiences
with paediatric SLP services. There is currently a large
gap in information available on how to support Aboriginal
families to access paediatric SLP services and this pilot
study aimed to gain an initial insight into factors that may
affect attendance and engagement with SLP services.
Several factors affecting attendance and engagement
with other health services have already been identified in
the literature, particularly, access, relationships and the
presence of Aboriginal staff.
Access to health care services by
Aboriginal families
It has been reported that a reduced number of Aboriginal
families access mainstream (i.e., not Aboriginal-specific)
childhood health care services, including early childhood
services (Ou, Chen, Garrett, & Hillman, 2011), disability
services (DiGiacomo et al., 2013), and occupational therapy
services (Nelson & Allison, 2004). Reduced access to
speech pathology services has been linked to lack of
awareness of what the service provided (Nelson & Allison,
2004; DiGiacomo et al., 2013), and beliefs around the
causes of communication impairment. For example, Berndt
(1982) reported that traditional Aboriginal beliefs attributed
hearing problems to a ghost kidnapping the child and
attributed speech problems to a softening of the tongue.
Access to both services and transport has been identified
as an issue for Aboriginal families in both rural and urban
areas (Eades et al., 2010; NACCHO, 2001). Services
offered within environments not requiring travel (e.g.,
school-based occupational therapy service) were rated
highly by parents (Nelson & Allison, 2004).
Relationships and communication
Relationships have been identified as especially important
to Aboriginal people, including the relationships between
Aboriginal people and health care workers. Having a
positive relationship has been described as “pivotal” to
successful outcomes for working with Aboriginal people
(Nelson & Allison, 2007). The relationship should be built on
appropriate communication (DiGiacomo et al., 2013) and
can often take time to build and develop (Nelson & Allison,
2007). A SLP study with non-Aboriginal families found a
good relationship was an important predictor of satisfaction
with SLP services, while a poor relationship may be
implicated in disengagement from services (McAllister et al.,
2011).
Speech-language pathologists may be
uncertain about how to work with Aboriginal
families. However, Aboriginal children are at
increased risk of communication impairment,
due to a range of risk factors. The aim of this
pilot study was to identify factors that
assisted Aboriginal families to attend and
engage with paediatric speech-language
pathology (SLP) services and to gain
feedback from caregivers on ways to improve
the cultural-appropriateness of these
services. Semi-structured telephone
interviews were conducted with ten
caregivers of Aboriginal children attending a
mainstream (i.e., not Aboriginal-specific) SLP
service. The participants’ responses related
to three themes: the client and caregiver, the
health service, and the community and
Aboriginal culture. Possible solutions for
improving services were provided by the
caregivers, which included providing
information to families about what to expect
from therapy, services being flexible with
appointments, and displaying Aboriginal
artwork. The need for further rigorous
research in the area is highlighted.
Many speech-language pathologists are reportedly
uncertain of how to work with Aboriginal
families (Cahir, 2011). However, it is critical to
improve practice, particularly as Aboriginal children in
Australia experience poorer health and well-being than
non-Aboriginal children (ARACY, 2013), including a higher
risk for communication impairment. Factors impacting
on communication include higher rates of otitis media
(Couzos, Metcalf & Murray, 2001), low literacy rates (Pink
& Allbon, 2008), and increased likelihood of being in
foster care (Nathanson & Tzioumi, 2007). Webb (2012)
identified that modifications to traditional service delivery
(e.g., allowing time to develop relationships with Aboriginal
families before commencing therapy, conducting services
within the Aboriginal community) are required for therapy
to be effective with Aboriginal families in paediatric speech-
language pathology (SLP) services. To date, no Australian
Aboriginal families’
experiences of attending
speech-language pathology
services
Laura Graham and Nicole Byrne
Laura Graham
(top) and
Nicole Byrne
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