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JCPSLP Volume 15, Number 3 2013 135
vulnerable group. The key themes in relation to linking in
with internal and external partners to support families
(COAG, 2009) ensure children in OOHC maintain links with
services, despite placement/caseworker changes.
It is acknowledged that this discussion paper provides
an overview of the strategies that have been implemented
in a single SP service and thus may not be transferable
to all SP services. The challenges identified herein are the
most common ones for this service, and other services
may face different challenges and/or have differing solutions
for working with these clients. The strategies identified in
this paper as successful are based on anecdotal reports
and stakeholder feedback; the authors note there are
future opportunities to conduct a formal evaluation of these
strategies.
It is also acknowledged that the identification of
challenges and strategies to overcome them is not
complete. There are many opportunities for the service to
continue to develop and improve the intervention provided
to children in OOHC. For the current service the ongoing
work with this vulnerable group includes:
• increasing the speech pathology staff’s understanding
of the impact of different types of maltreatment on
predicting speech/language delays (Culp et al.,1991)
(to support appropriate diagnostic/prognostic planning
and management); staff will continue to be provided with
education from a multidisciplinary perspective, guidance
as to professional development opportunities in this field
and current relevant research;
• improved mechanisms to support speech pathologists
such as providing ongoing clinical support and
education, and maintaining OOHC as a regular agenda
item in service meetings;
• linking in to other multidisciplinary services for this client
group (Hwa-Froelich, 2012);
• ensuring intervention is based on current evidence-
based practice principles;
• the development of standardised assessment protocols
in order to develop a thorough picture of the types of
communication disorders these children present with
and to tailor intervention to meet their needs.
The authors have highlighted that speech pathology
caseloads are seeing an increase in the number of children
in OOHC as a result of maltreatment, and there needs to be
discourse within the speech pathology profession regarding
this vulnerable group. It is hoped that this paper will raise
awareness of the needs of this client group and encourage
similar services to document their challenges and strategies
The speech pathologist
Speech pathologists are increasingly required to provide
intervention to children in OOHC. The issues arising with
these children are typically complex given the nature of their
family situation, history and severity and complexity of their
speech/language delays (Allen & Oliver,1982; Culp et al.,
1991; Eigsti & Cicchetti, 2004; Hwa-Froelich, 2012).
Speech pathologists have varied levels of self-confidence
and experience working with vulnerable groups, including
OOHC. For new staff, working with children in OOHC may
be an unfamiliar caseload. This has been addressed by the
service through establishment of a designated SP OOHC
coordinator position. This position provides staff with a key
contact for support, mentoring, clinical supervision,
orientation of new staff to the challenges of working with
this caseload, provision of education related to working with
maltreated children, and supports staff regarding the
content of child protection training. This service
implemented a number of strategies to engage and upskill
all SP staff in this area (see Table 5).
The speech pathology service
Children with speech and language delays are at greater
risk of abuse, neglect or trauma (Westby, 2007). Fox,
Almas, Degnan, Nelson and Zeanah (2011) suggested it
may be more challenging to care for children with a mild
language delay than for children without a language delay,
and their limited language abilities may make interactions
with them unsuccessful and unrewarding, thus raising a
greater exposure to maltreatment. Sullivan and Knutson
(2000) reported that parental expectations may be unrealistic
and are influenced by heightened levels of stress. As a
result, in some cases it may be difficult to ascertain whether
the language delay or the maltreatment occurred first.
The Kaleidoscope SP OOHC coordinator maintains a
centralised database of all children in OOHC referred across
seven service sites and tracks the child’s journey through
SP services, including ensuring follow-up (e.g., if child fails
to attend) occurs. In endeavouring to ensure consistency of
SP services across the seven sites, a number of strategies
have been implemented (see Table 6).
Conclusion and future directions
The steady increase in referrals to this service over the past
two years suggests that the number of referrals of children
in OOHC as a result of maltreatment will likely see
continued growth. The speech pathologists identified a
number of unique challenges that were common to children
who were in OOHC, suggesting they are a discrete and
Table 5. Challenges and strategies for the speech pathologist
Challenges Strategies
During the intervention the speech pathologist may become Managers have ensured support mechanisms (e.g., information on employee
privy to information that is outside their comfort zone, counselling services, confidential debriefing) are in place
especially for inexperienced staff
Imbalance of caseload numbers of children in OOHC based on Support is offered to speech pathologists at sites with large numbers of OOHC
different sites’ geographical locations children on their caseload
Ensure even distribution of cohort across SP staff
Child protection training may be confronting and distressing Staff are prepared regarding the content of child protection training
for staff.
SP service does not operate within a multidisciplinary service
model which has implications for cross-referral, Developed links with relevant multidisciplinary services and discuss appropriate
multidisciplinary goal-setting and of the speech pathologist streamlining of referrals, goal setting
potentially being asked questions related to other professions
(e.g., psychology)