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ACQ
Volume 12, Number 3 2010
ACQ
uiring knowledge in speech, language and hearing
Working with clients to improve their access through
addressing environmental and personal factors may seem
daunting. This article, however, is a good point to begin such
reflection.
Hospital access for families of injured children:
A multi-ethnic perspective
Arlidge, B., Abel, S., Asiasiga, L., Milne, S.L., Crengle, S. &
Ameratunga, S.N. (2009). Experiences of whanau/families
when injured children are admitted to hospital: A multi-ethnic
qualitative study from Aotearoa/New Zealand.
Ethnicity &
Health
,
14
(2), 169–183.
Clare McCann
This highly relevant and informative qualitative study forms
part of a larger multi-ethnic investigation of the perceptions
of injured children, their families and healthcare providers, in
order to understand the impact of injury and the barriers and
facilitators to recovery following injury. This paper focuses on
the experiences of families when a child is admitted to a
hospital following an unintentional injury.
The authors are well regarded for their research into
health inequalities for Maori and Pacific peoples so it is
no surprise that they begin this article by outlining the
relative overrepresentation of these minority groups in the
healthcare systems as a consequence of colonisation and
lower socioeconomic status. They go on to challenge the
conventional methodology of research
on
Maori and Pacific
peoples rather than
for
and
by
Maori and Pacific peoples.
One is reminded of the concept of “user involvement” now
being promoted in the aphasia literature and so eloquently
presented by Carole Pound at the Speech Pathology
Australia conference in Melbourne in May 2010. After
discussing their findings, the authors conclude with their
recommendations for improving health services and policy.
Twenty-three families representing Maori, Pacific and
Pakeha (New Zealand European) were interviewed. Culturally
appropriate practices were employed for the qualitative
interviews including the option for families to be interviewed
in their own language. The flexible, narrative approach to
the interviews allowed families to tell the story of their child’s
injury and the stages of care and recovery (within hospital
and at home). The data were analysed and coded into main
themes. Despite many families praising the dedication of
staff and expressing their satisfaction with overall care, four
main themes revealed their concerns with the health services
provided. The themes were 1) inadequate communication
and information, 2) difficulty negotiating the hospital
environment, 3) stress of conflicting demands and 4) issues
relating to ethnicity and cultural miscommunication. Each
of these themes was discussed in detail and supported
by illustrative quotes from the participants. These findings
highlight important implications for the delivery of healthcare
services.
While relatively few speech pathologists work in an
acute paediatric hospital setting, the culturally appropriate
methodology of this study and the finding of the four
themes must surely resonate for us all. In particular we are
challenged to reflect on our intercultural communication
with clients and their families, the appropriateness of the
information (written and verbal) that we provide to them,
and the support we give them in dealing with the competing
demands of living with a communication impairment and
coping with everyday life (work, other children, family
expectations).
time- and resource-stretched services, one of the strengths
of these articles is the concrete examples they provide
on how communication access can be broken down
into manageable chunks. The second article in particular
provides a structured approach to enable service providers
to reflect upon their service, evaluate, and make changes to
communication access.
For individuals with aphasia and other communication
disabilities, the importance of communication access cannot
be underestimated. Alan Hewitt (staff member with aphasia
at Connect, and co-author of these two articles) describes
its significance succinctly: “If it’s not clear I can’t take part.
Nor can lots of others who have aphasia. Communication
access is the way in to real involvement ... not just
involvement around the edges” (Pound et al., 2007, p. 33).
Speech pathologists who read these two articles will find it
difficult to resist the inspiration to take a second look at how
communicatively accessible their own services are, to initiate
processes to make changes (however small), and to begin
spreading the word on communication access to others.
Well worth a read!
Access for persons with neurogenic
communication disorders
Threats, T. (2007). Access for persons with neurogenic
communication disorders: Influences of personal and
environmental factors of the ICF.
Aphasiology
,
21
(1), 67–80.
Brooke Grohn
This article provides the reader with an insight into the
meaning of access for people with neurogenic
communication disorders in relation to the Environmental
and Personal Factors of the World Health Organization’s
International Classification of Functioning Disability and
Health (ICF; WHO, 2001). It also highlights the complexities
associated with the issues of access both within the clinical
and research fields.
The author begins the article by providing definitions of
access and the Environmental and Personal Factors of the
ICF. This is followed by a comprehensive discussion of the
issues related to research surrounding environmental factors
and access. Key points highlighted by the author are that
research has tended to focus on the barriers to access
rather than the facilitators and that there are few tools
available to reliably measure environmental factors. Despite
this, the author describes the rehabilitation framework The
Life Participation Approach to Aphasia (LPAA) and the
work by Connect – The Communication Disability Network
as examples of where some progress has been made.
The author also challenges the profession by considering
whether clinicians are potential barriers and/or facilitators to
access and suggests that clinicians need to reflect on their
role in promoting access for people with communication
disorders.
The role of personal factors in supporting a client’s
access is also explored. For example, the author describes
the role of the speech pathologist in promoting the client’s
self-advocacy and highlights a number of key personal
factors such as personality traits and past experiences that
should be considered when facilitating access. A variety
of scenarios are provided to highlight the intricacy of such
considerations. For instance, one example illustrates the
potential adjustments that could be made to intervention
as a result of considering an individual’s copying style and
response to communication disability.